


■ 






1 



I 



Its Curability 



LIBRARY OF CONGRESS, 



UNITED STATES OF AMERICA. 



*y 



\K 




MAP of the VISCERA. 

i. Gall Bladder. 3- Liver Duct. 

2. Gall Duct. 4- Common Duct. 

5. Pancreatic Duct. 



WHAT IS 



Brights Disease? 



Its Curability. 



WHAT IS 



Brights Disease? 



Its Curability. 



By SETH PANCOAST, M. D., 

Specialist in the Treatment of Chronic Diseases ; Author of Ladies' 

Medical Guide, Treatise on Consumption, 

The Kabbala, etc., etc. 



v 



WITH ILLUSTRATIONS. 






^OFWASHl^ 

Philadelphia : 



PUBLISHED BY THE AUTHOR. 
1882. 



1/ 



\ 






K 






Copyrighted, 1882, by 
SETH PANCOAST, M. D. 



TO 

THE SUFFERERS 
FROM 

BRIGHT'S DISEASE, 

WITH 

A HOPE THAT THEY MAY FIND INSTRUCTION 

AND 

CONSOLATION IN ITS PERUSAL. 



PREFACE. 



It is customary in the preface for the author 
to assign reasons, and offer an apology, for 
writing the work. We have reasons for writ- 
ing which we will state, but no apology to 
offer. 

The disease of which we treat in this work 
is regarded hy many physicians as incurable, 
even in its acute, but especially in its chronic 
form. In our opiuion, the failure to treat, it 
successfully is due largely to a wrong concep- 
tion of its nature and cause, and this book 
is written for the purpose of expressing the 
author's ideas, and affording hope to those 
suffering from this terrible malady. We claim 
that the primary cause lies in the organic ner- 
vous system which controls the nutrition and 
growth of the entire organism, as well as the 
elimination of the products of disintegration. 

In the secreting structure of the kidneys 
the disease is supposed to be first mani- 
fested. This is a mistake, for it may exist for 
many months, if not years, before albumen is 
detected in the urine. The kidneys are not the 

9 



10 PREFACE. 

only organ involved when the disease be- 
comes fully developed; we find the heart, 
lungs, and liver participating, and this cannot 
be from sympathy with the kidneys, but is due 
to an ennervation of the nervo-vital energy, 
the master-workman in controlling the func- 
tions of the physical organism. The condi- 
tions under which Bright* s Disease makes its 
appearance, may be lurking in the organic ner- 
vous system for years, before the patient, his 
friends, or even his physician is cognizant of 
it, and all at once, some exciting cause, such 
as mental strain, cold, debauch, etc., reducing 
the vital energy, brings it to the surface. So 
long as it is treated as a local disease, exclu- 
sively, successful results cannot be expected. 

We have fully demonstrated its curability 
within the last few years, to our own satisfac- 
tion, as well as to that of many we have 
treated. The ennervation of the vital energy 
centered in the organic nervous system must 
be corrected or replaced by normal action be- 
fore local treatment applied to the kidneys 
can assist in reducing the inflammation, thus 
enabling the vital energy to overcome structu- 
ral changes that have occurred, and to restore 
the organ to its normal action. Great care 
must be observed by the patient for fear of a 
relapse, which is liable to occur until normal 



PREFACE. 11 

vital action is firmly re-established. Our motive 
in writing this work is evident : it is to set 
forth our views on Bright' s Disease, and to 
assure those who are suffering from it of its 
curability, if there be not already too great an 
ennervation of the vital energy and disintegra- 
tion of the kidneys. 

In conclusion, we would remark that repe- 
tition of words and phrases, and even of state- 
ments, is unavoidable in a work of this char- 
acter, written expressly for non-professional 
readers. 

Seth Pancoast. M. D. 

917 Arch Street, 

March 1st, 1882. 



CONTENTS. 



CHAPTER I. PAGB 

The Structure of the Kidneys, 15 

CHAPTER II. 

The Nervous System, $3 

CHAPTER III. 

Function or Office of the Kidneys, 55 

CHAPTER IV. 

Abnormal Condition of the Kidneys in 

Bright's Disease, $3 

CHAPTER V. 

What is Bright's Disease? It's Curability, . 97 

CHAPTER VI. 

Symptoms of Bright's Disease, 116 

CHAPTER VII. 

Causes of Bright's Disease, 

CHAPTER VIII. 

Advice to those Suffering from Bright's 
Disease, 

13 



DEFINITIONS. 

Correlation and its Cognates. — " Correlation'/' is 
derived from the Latin con-elatio, a triple-compound word, 
from latus the participle passive preterite oifero, with the 
successive prefixes re-, and con- ; etymologically, it denotes 
" a bearing back upon" a person or thing; thus, the ordi- 
nary dictionary definition is "a reciprocal relation," etc.; 
but we employ this substantive, " correlation," and its 
cognate adjective and verb, in a specific or technical ap- 
plication, to denote the peculiar relation that obtains 
between the Subjective, Primary Force, on the one hand, 
and the Objective, Secondary Force, on the other hand. 
The former is the direct instrument of the Spirit, and is 
the Vital, the Life Force ; the latter is the same manifested 
in material organization, as Nerve Force — the one centres 
in the Soul, the other in the Nervous System of the Living 
Organism. As the Soul and body of every living entity 
are developed simultaneously, the Primary and Secondary 
Forces must correlate in action and operation. 

Nervo-Vital. — The foregoing definition suggests the 
signification of this term ; the Spiritual Vital Force of the 
Soul, to develop and sustain the physical bodv, must es- 
tablish itself with the Secondary Nerve Force, and the 
two correlate as the Nervo-Vital Force. 



14 



CHAPTER I. 
Structure of the Kidneys. 

[See Frontispiece.] 

The form of the kidneys somewhat re- 
sembles the ordinary bean, the inner margin 
being concave and extending inward towards 
the spine; the outer edge is thick and 
rounded and directed outwards. They are 
situated deep in the lumbar region, on each 
side of the spine ; the right is slightly lower 
than the left, being depressed by the liver 
which lies immediately above it. The kid- 
neys are occasionally out of their natural 
position — either in front of the spine or 
much lower down in the abdominal cavity 
— even as far as the cavity of the pelvis. 
They are embedded in adipose or fatty tis- 
sue, which is very profuse in fat persons, 
while in thin, spare individuals, there is 
scarcely a trace of it. The average length 
of these organs is four to four and a half 
inches, breadth two inches, and thick- 
ness one inch ; the weight in males is five 
to six ounces, in females, four to five ounces. 

15 



16 BRIGHT'S DISEASE. 

They are partially covered by the perito- 
neum, which lines the abdominal cavity. 
The right kidney is covered by the ascend- 
ing colon or the ascending part of the large 
intestine, and the left by the descending 
colon, or descending part of the large intes- 
tine. The right kidney is also in contact 
with the duodenum and covered by the 
right lobe of the liver, and occasionally a 
part of its anterior surface is covered by the 
gall-bladder. The left kidney lies in con- 
tact with the spleen and is covered by the 
large end of the stomach, when it is dis- 
tended during the process of digestion. It 
is important to understand the relation of 
the kidneys with the colon or large intes- 
tines. Abscess of the kidneys has been 
known to burst into, the colon, and the 
ulceration of the intestines would cause se- 
rious structural change in the kidneys. 

On the concave and spinal margin of the 
kidney is a small depression or fissure, 
called the hilum, through which the arteries 
and nerves pass into the kidney and the 
veins pass out. It is this depression where 
the pelvis of the kidney begins. The ureter 
or excretory duct extends from the hilum 



THE BLOOD-VESSELS. 17 

to the base of the bladder. It is a small 
canal composed of elastic tissue, varying 
in size from a chicken to a goose quill. 
At its commencement in the kidney and its 
terminus in the bladder, it is dilated but be- 
comes narrowed near the middle. It is in 
the contracted portion of the ureter that 
urinary calculi or gravel become lodged, in 
their passage from the kidneys to the blad- 
der, causing excruciating pain. This tube 
is lined by a delicate mucous membrane 
similar to that which lines the bladder and 
kidneys. 

The Blood- Vessels of the Kidneys : — 
These consist of the renal artery and vein ; 
the former is a branch of the abdominal 
aorta and, previous to its passage into the 
kidney, it gives off branches to the capsule, 
ureter and surrounding cellular tissue. After 
it enters the kidney, it divides into four or 
five branches and again subdivides into 
smaller branches forming the Malpighian 
tufts, which we will describe when speaking 
of the minute structure of the kidneys. 

The vein rises in the substance of the kid- 
neys from the capillaries and conveys the 
blood out of the kidneys into the vena cava. 

2* 



18 



BRIGHT'S DISEASE. 



The Nerves of the Kidneys: — These 
consist of branches from the lower and outer 
border of the semi-lunar ganglion and the 




Fig. i. 
Longitudinal section of the kidney, with its renal capsule, i, 
Renal capsule; 2, cortical or vascular parts of the kidney ; 3. 3, urini- 
ferous tubes collected into a conical form ; 4, 4, papillae projecting 
into their corresponding calces; 5, 5, 5, the three infundibula ; 
6, pelvis of the kidney ; 7, ureter. (After Dr. Morton.) 

solar plexus formed by the descending 
branches of the small splanchnic nerve. 
The General Structure of the Kid- 



GENERAL STRUCTURE. 19 

neys. — If a kidney be moved from its posi- 
tion and stripped of its adipose and loose 
fibrous tissue, we find it completely covered 
with a capsule, formed of dense fibrous tis- 
sue, which not only encloses the body of 
the kidney but is continuous with the pelvis 
and ureter. If a longitudinal incision be 
made through its outer border/ we per- 
ceive that it is composed of two distinct por- 
tions differing materially in appearance. 
The external is called the cortical and the 
internal the medullary portion; the former 
is about two lines (one-sixth of an inch) in 
thickness. Its color will depend upon the 
quantity and character of the blood it con- 
tains. When normally supplied with healthy 
blood, it is of a light-red color. In anaemic 
subjects where there is a deficiency of red 
corpuscles, it presents a yellowish-white 
appearance. If we examine the structure with 
a low magnifying power, we find it made 
up of secreting tubes called tubuli uriniferi, 
blood vessels, and Malpighian tufts or glom- 
erules. In the cortical substance these 
tubules are very tortuous ; as we descend 
in the substance of the kidney, they become 
straight, forming the pyramids of Malpighi. 



20 BRIGHT'S DISEASE. 

The medullary substance, or as it is some- 
times called the tubular portion, of the kid- 
neys is much less dense than the cortical 
substance and assumes the form of cones 
or pyramids with the apices downward, and 
the bases upward. The apices of these pyra- 
mids are called mammillary processes or pa- 
pillce. The number in each kidney varies ; 
usually, however, there are from twelve to fif- 
teenin each. Some of them are compound, 
being formed by the union of two which have 
a common mammillary termination. The 
cut surface of a pyramid presents a striated 
appearance, being composed of tubes, 
named the tubes of Bellini, who first dis- 
covered their tubular character. They are 
united by a fine net-work of fibrous tissue, 
in which we find associated some large 
veins which assume a straight course be- 
tween the tubes. The papillae of each of 
the cones have several openings, from 
which the urine escapes into the calces and 
infundibula. No Malpighian bodies are 
found in the medullary portion of the kid- 
neys; they only exist in the cortical sub- 
stance. 

Pelvis of the Kidney. — This is a strong, 



PELVIS OF THE KIDNEY. 



21 



fibrous pouch, divided into three compart- 
ments, called calces — one at each end, and 
one intermediate or in the middle. Each 




Fig. 2. 

Vertical section from the cortical 
surface of the kidney to the apex of 
one of the medullary cones q, c, 
bundles of straight tubes passing 
towards the surface, a, i; the same 
observed at o and p ; at /, the straight 
tubes terminate in what is designated 
Henle's loop and become tortuous ; 
q, s, t, straight tubes with their 
dichotomous divisions; h, artery ter- 
minating in a cluster of Malpighian 
bodies ; s, apex of one of the medullary 
cones terminating in a mammillary 
process or papilla. (After Schum- 
lausky.) 



one of these calces is again divided into 
three or four funnel-shaped processes, called 
infundibula, which embrace the papillae at 



22 BRIGHT'S DISEASE. 

their upper or basal extremity. In some 
anatomical works calces and infundibula are 
synonymous or convertible terms. From 
these calces the urine passes into the pelvis 
of the kidney, which is of a flat, oval form, 
terminating in the ureter. 

The Ureter. — The ureter is about the 
size of an ordinary quill, formed of fibrous 
tissue, lined its entire length by a mucous 
membrane. It is from fifteen to eighteen 
inches long, and enters the bladder obliquely, 
which obliquity answers the part of a 
valve, preventing a regurgitation of urine 
after it has passed into the bladder. 

Minute Structure of the Kidneys. — 
In this division we will consider the follow- 
ing structures : 

1. Fibro-cellular structure. 

2. The Tubuli Uriniferi, or uriniferous 
tubes. 

3. Malpighian Tufts, or Glomerules. 

1 . The Fibro-cellular Structure. — This por- 
tion consists of a fibrous net-work, the 
meshes of which support the tubes, blood- 
vessels, nerves, etc., and is therefore the 
frame-work of the kidneys. It consists of 
fibro-cellular tissue, and its office is mechan- 



MINUTE STRUCTURE. 



23 



ical ; it undergoes no change, and is there- 
fore regarded as permanent tissue. 

2. The Uriniferous Tubes. — It is diffi- 




Fig. 3 . 
Microscopic view of secreting structure of the kidney. 1, the 
renal artery, which at 2 sends a twig to the Malpighian copuscle; 
3, convoluted tuft, capillary ball or glomerule, enclosed by the cap- 
sule. The capsule, is seen at 4, and at 5 contracts into a tortuous 
uriniferous tube or duct of Terrian; 6, the efferent vein bringing 
back the effete blood, joins the veins 7 and 9 from other capsules, 
and thus forms the venous capillary plexus around the uriniferous 
tubes; 8, these capillaries converge and end in the emulgent vein. 
(After Dr. Morton.) 

cult to trace these tubes from either the 
cortical substance, or from the apex of the 
medullary cone. If we commence at the 



24 



BRIGHT'S DISEASE. 



latter point, we find them pursuing a com- 
paratively straight course in the medullary 
portion of the kidneys [Figs. I and 2], but 
dividing and subdividing until they reach 
the cortical substance, when they become 
very tortuous, and terminate in a closed 
cavity, very much larger than the tube 



Fig. 4. 

a, The arrangement of the epithelium 
cells in the tortuous and excretory portion 
of the uriniferous tubes ; 3, the epithelium 
arrangement of the cells in the straight or 
non-excretory portion of the tubes. (After 
Heidenhain.) 



[see Fig 3]. It is the division and subdi- 
vision of these tubes that forms the base of 
the pyramid, and causes it to be uppermost. 
The spherical enlargement of the tubes 
is called the capsule, and is 1- 150th of an 
inch in diameter [see Fig. 3]. The tube 
below the capsular neck is 1 -480th of an inch 
in diameter. Their structure is very delicate, 
consisting of a basement or germinal mem- 
brane, and an epithelium layer of cells. As 



BASEMENT MEMBRANE. 



25 



it is important to make our subject clear 
to the unprofessional reader, it will be ne- 
cessary for us to be very exact in our 
description of this germinal membrane, and 
the mucous cells that rest upon it [Figs. 
4 and 5]. This structure was first dis- 







Fig. 5. 
Diagrammatic representation of the basement membrane, and 
the vital changes that occur in its protoplasma, in the development 
of epithelium cells ; d, capillary blood-vessels which form the floor 
of the basement membrane; c, the protoplasma eliminated from the 
blood-vessels, called the basement membrane or formless matrix; b. 
the same vitalized by nervo-vital energy, becomes granular, which 
aggregate and form nuclei ; a, epithelium layer of cells resting 
upon the outer surface of the so-called basement membrane. 

covered by Bowman and Professor Good- 
sir; the former named it the basement mem- 
brane, on account of its being the basis upon 
which the epithelium and epidermic cells 
rested, and the latter called it the primary 
or germinal membrane, believing it to fur- 
nish the germs of the above named cells. 
In its most primitive form it te a homoge- 



26 BRIGHT'S DISEASE. 

neous fluid layer, so minute that it is inca- 
pable of measurement. In its more ad- 
vanced state of development, we find on 
the upper surface granular particles, upon 
which rest the epithelium cells. Before 
these cells are formed the granules unite, 
forming nuclei, each one of which possesses 
inherent energy to inclose a portion of the 
protoplasm of the basement membrane, by 
the formation of a cell-wall. The nucleus 
is now enclosed, and is in a condition to 
impart vito-chemical change to the cell 
contents. This consists of converting the 
contents of the cells resting upon the base- 
ment membrane into the solid constituents 
of the urine, which is a purely vital process. 
When this metamorphosis occurs, the life 
of the cell ceases, and its contents pass into 
the uriniferous tubes; other cells imme- 
diately form to take their place. The inte- 
gration and disintegration of epithelium 
cells is very rapid, depending, however, 
upon the amount of fluid blood iliminated, 
and the vital energy imparted by the 
organic or sympathetic nervous system. 
We will show in a future chapter that the 
office of these cells is to eliminate the morbid 



BASEMENT MEMBRANE. 27 

products of decay containing nitrogen. In 
Bright's Disease the energy imparted by 
the organic nervous system is impaired, 
causing a change of function, and if the 
disease is not arrested, a structural change in 
the tubes takes place, and finally, completely 
suspending the office of the kidneys, causes 
a retention in the blood of nitrogenous 
products, blood poisoning, and death. YVe 
thus perceive that the basement membrane 
is an exudation from the blood, to which 
the organic nerve filaments are distributed, 
changing it to a granular form, which sub- 
sequently unite and form nuclei. The for- 
mation and character of the epithelium are 
the same in all glandular structures, yet 
their functions differ. In the liver they 
secrete bile, consisting of carbon and hydro- 
gen ; in the kidneys, urea, etc., containing 
nitrogen; in the stomach, a gastric juice; 
in the glands of the mouth, a salivary secre- 
tion, etc. 

Attached to the outer surface of the epi- 
thelium cells are hair-like appendages, 
called cilia [Fig 5]. They vary from 1-5 ooth 
to i-ioooth of an inch in diameter, and when 
in motion bend from their attachments in 



28 BRIGHT'S DISEASE. 

the cell to their points, returning again 
to their original state, like a field of wheat 
when depressed by the wind. Their motion 
is derived from the nucleus of the cell, and 
their office is to assist the movements of 
the products secreted by the cells, their 
motion being downwards. In some organs, 
particularly the reproductive of the female, 
their movements are upwards and inwards. 
Ciliary motion continues as long as the cell 
retains its vitality, the motion continuing 
sometimes after death has apparently oc- 
curred. It is stated by some writers to 
continue until decomposition ensues. 

3. Malpighian T?ifts y or Glomerides. — 
These bodies have been objects of great 
interest since their discovery by the dis- 
tinguished anatomist whose name they 
bear [Fig. 3 and 6]. Malpighi believed 
them to be internal glands, which could be 
readily injected from the arterial branches 
to which they were appended. He also be- 
lieved the urinary constituents were sepa- 
rated from the arteries of these bodies, and 
that the uriniferous tubes were excretory 
ducts of these glands. Schumlausky was 
the first to arrive at a correct knowledge of 



MALPIGHIAN TUFTS. 



29 



these bodies and their connection with the 
uriniferous tubes. He described the Mal- 
pighian bodies as consisting of glomerules 
of vessels connected on one side with the 



Fig. 6. 

Malpighian body, etc., from 
the horse, a, arterial branch; /, 
the arterial twig, or afferent ves- 
sel ; m, the Malpighian tufts ; f, 
the vein, or afferent vessel ; at b, 
its branches enter the medullary 
cone. (After Bowman). 




arteries, and on the other side with the 
veins. He further believed there was a' 
close connection between them and the 
tubes, but was unable to define it. From 
1788, the time of Schumlausky's work, to 
3* 



30 BRIGHT'S DISEASE. 

1842, when Mr. Bowman published his 
paper on the same subject, but little had 
been added to the knowledge of the Mal- 
pighian bodies. 

We give Bowman's description of this 
intricate structure, and the wonderful adap- 
tation of means to ends, affording undoubted 
evidence of an infinite Designer. He de- 
monstrates that the capsule on the upper 
extremity of the uriniferous tubes is 
pierced by a twig of the renal artery [Fig. 
3], which suddenly breaks up into three, 
four, or eight branches, diverging in all 
directions, like the petals on the stalk of a 
flower, and usually assuming a more or less 
tortuous course, subdividing once, or more, 
in the formation of the vascular ball or tuft. 
The vessels resulting from these various 
divisions are capillaries, with thin, trans- 
parent, membranous walls. After this com- 
plex subdivision they twist into a single, 
small vessel about the size of the arterial 
twig from which the ball originated. This 
vessel then emerges from the capsule, near 
the artery. Both twigs, as they pass in and 
out, adhere closely to the capsule. This 
tuft or capillary ball is held together by a 



THE CIRCULATION. 31 

mutual interlacement, there being no other 
tissue admitted into the capsule ; it lies per- 
fectly loose and bare in its inclosure. Since 
Bowman's discovery the German and French 
physiologists particularly have asserted that 
the glomerules are lined by a delicate 
mucous membrane, which is the first to 
undergo a change in Bright's Disease. Be 
this as it may, the office of the epithelium 
must be unnecessary for the elimination of 
the watery portion of urine, which is merely 
a filtration. 

The Circulation of the Kidneys. — It 
is important to understand the circulation 
of the kidneys, in order to familiarize our- 
selves with their functions, in health and in 
disease. We have previously stated that 
the renal artery sends a twig to the capsule 
of the uriniferous tubes which divide and 
subdivide, forming a tuft of capillaries. 
These terminate in a single vessel which 
passes out of the capsule and anastomoses 
with branches from other Malpighian bodies, 
and they form a plexus of capillaries which 
anastomose around the uriniferous tubes, 
forming a continuous net-work outside the 
tubes and in close contact with its basement 



32 BRIGHT'S DISEASE. 

membrane. We thus have two sets of 
capillary vessels in the kidneys, one forming 
the glomerules, the other the plexus around 
the tubes [Fig. 3]. This plexus converges 
and ends in the emulgent or renal vein 
[Fig. 6] which emerges from the fissure 
of the kidney and terminates in the vena 
cava. It is well to note, that arteries con- 
vey blood to an organ which terminate in 
capillaries, and the capillaries terminate in 
veins which convey the blood from an organ. 
The arteries take blood to tissues and or- 
gans to supply them with nutrition and the 
veins take it back to the heart, leaving the 
products of waste at the excretory organs. 
When speaking of the function of the kid- 
neys, we will show that the uriniferous tubes 
secrete the solid constituents of the urine, 
and that the Malpighian tufts eliminate the 
watery portions. The nerves of the kidneys 
will be explained in a separate chapter in 
which we shall speak of the vital energy. 



CHAPTER II. 

The Nervous System. 

As it is in the nervous system that the 
vital energy is located, it will not be out of 
place to devote a short chapter to its struc- 
ture and functions. All organic structure 
in which active life exists, has a nervous 
system of some form ; it may consist of 
simple granules in a mass of protoplasm, as 
we find it in the amoeba. Some deny its 
existence in the lowest organic forms, which 
are apparently structureless, yet there is 
evidence of sensibility and automatic action, 
and as these are only to be found in the 
nervous system, the inference is that such 
a system exists in these lower organisms, 
in a very rudimentary form. The granules 
are centres of vital energy, which subse- 
quently become aggregated in nuclei, having 
the power of forming cells out of proto- 
plasm. Therefore the most rudimentary 
form of nervous system consists of granules 
or corpuscles, possessing a centralizing en- 
ergy, capable of manifesting motion in un- 

33 



34 BRIGHT'S DISEASE. 

organized or structureless protoplasm. As 
the evolution of forms takes place, the 
granules aggregate and form nuclei, in 
which we have the energy increased. In 
the higher state of organic unfoldment we 
find the nuclei enclosed by cell-walls, which 
they have the power of forming. In order 
to concentrate the energy to meet the re- 
quirements of higher organic development, 
ganglia are formed, which are the aggrega- 
tion of cells, free nuclei, granular particles, 
albumen, and fatty matter. 

In the Radiata, we find a single ganglion 
with projecting nerve fibres ; in the Articu- 
late the form is more complex, and a 
greater differentiation is required. There 
are several ganglia joined together by 
nerves called commissures, and nerves lead- 
ing to and from the ganglia to different 
parts of the organism. In the lower types 
of Vertebrata, a step higher in the evolution 
of form, we have a spinal system, and a 
miniature brain, which is gradually un- 
folded in the successively higher types until 
perfected in man. We thus perceive that a 
centre of nervo-vital energy may be a 
simple granule, a nucleus, or a ganglion. 



THE. NERVOUS SYSTEM. 35 

The nerves are entirely different in struc- 
ture from the ganglia, and possess a very 
different function. The ganglia are centres, 
and the nerves are the distributers of energy. 
A nerve is a minute tube, in the centre of 
which is a medullary substance, consisting 
of albumen and fatty matter. Embedded" 
in this pulpy mass that fills the entire tube, 
is a delicate fibre, which is the nerve proper, 
and called the axis cylinder; this central 
fibre is uniform and continuous, unlike the 
pulpy mass that surrounds it. Inclosing 
the medullary mass is a dense, fibrous tis- 
sue that forms the wall of the tube called 
the neurilemma, which is continuous with 
the ganglia, and forms their outer structure. 
At the peripheral extremity of the nerve 
the medullary ceases [Fig. 7], in order to 
expose the nerve fibre to the granular mass, 
to receive impressions from the external 
world, and convey them to the centres of 
consciousness. After the fibre leaves its 
medullary encasement it forms into an 
anastomosing loop and returns again to its 
pulpy covering. When a nerve enters a 
ganglion it also leaves its medullary envelope, 
and when it emerges it again receives it, 



36 



BRIGHT'S DISEASE. 



showing conclusively that it is the central 
fibre that is the carrier of energy from the 
surface of the body to the seat of conscious- 
ness and that receives energy from the gan- 
glia and conveys it to different parts of the 




Fig. 7. 
Looped termination of r.erve fibres in the papillae of the skin, with 
the granules in which the central nerve fibre communicates. 

system. We thus perceive that the fibre 
unrobes itself, as it were, to receive energy; 
when it has done so, it robes itself to retain 
its energy until it is conveyed to where it is 
required. The medullary structure com- 
pletely insulates the fibre, as the cable is 
insulated that lies at the bottom of the 
ocean. There is a remarkable similarity 
between the electro-magnetic battery and its 
insulated wires and the ganglion and its 
nerves [Fig. 8]. The ganglion contains 
cells and nuclei in which is generated nerve- 
force, and the nerves distribute this force, 



THE NERVOUS SYSTEM. 



37 



the same as the electro-magnetic battery 
generates electro-magnetic force and the 
wires distribute it. These nerves are dis- 
tributed to all parts of the body. This can- 
not be better illustrated than by comparing 
it to a fine spider's web, the meshes of which 




e 

Fig. 8. 
Ganglion of the organic or sympathetic nervous system of the 
mouse, a, b, nerve fibres connecting the adjacent organic ganglia; 
c, c, c, c, nerve branches to the viscera and spinal nerves; d, gan- 
glionic cells, the seat of nervo-vital energy ; e % nerve fibres passing 
through the ganglion receiving energy from the cells. 

are so small that a needle's point could not 
touch any portion of the soft tissues without 
injuring one of these nerve fibres. 

The nervous system is divided into the 
cerebro-spinal (consisting of the brain and 
4 



38 BRIGHT'S DISEASE. 

spinal cord), and sympathetic or organic 
nervous system. The latter is the first to 
be developed, appearing in the lowest organic 
forms and is perfected in the articulated 
animals. In the vertebrated animals, which 
follow after the articulated, the spinal sys- 
tem makes its appearance, and, as we advance 
in this class, we find the brain gradually bud- 
ding out or developing from the upper por- 
tion of the cord, which is not fully unfolded 
until perfected in man. We regard the 
nervous system as a unit, having three 
stages of development. 

I. The sympathetic in which we find 
many of the functions, which are subse- 
quently localized in the spinal cord and 
brain. In the articulated animals in which 
this first division is developed we find sensi- 
bility, and automatic action, consciousness, 
muscular co-ordination, emotions, the sexual 
passions and instinct, all of which are trans- 
ferred to the spinal cord and brain when 
they are separated from the sympathetic 
nervous system. When the spinal cord is 
developed, automatic action is transferred 
to the medulla oblongata, the upper portion 
of the spinal cord. When the base of the 



THE NERVOUS SYSTEM. 39 

brain is unfolded, the seat of consciousness 
is transferred there. When the cerebellum 
or posterior of the brain is developed, the 
emotions, the sexual passions and muscular 
co-ordination are transferred to it. When 
the cerebrum or anterior brain is unfolded, 
we find the mind, which in the lower order 
of animals is represented by instinct. We 
thus perceive a gradual differentiation of 
the nervous system from the lower organic 
forms to man. These systems are so inti- 
mately connected that a serious injury 
occurring in any one of them finds a sym- 
pathy in the others. 

Notwithstanding the separate functions 
assigned to each system, there exists a 
reciprocal. relation; for example, if the pneu- 
mo-gastric or par-vagum nerve, which con- 
trols the action of the heart and respiration, 
be divided, the sympathetic nervous system 
cannot perform its normal functions, for the 
blood ceases to circulate, and oxygen, which 
is essential for chemical change, is not intro- 
duced into the blood by the lungs. There- 
fore nutrition, which office is assigned to 
the organic or sympathetic nervous system, 
cannot be carried on. If the sympathetic 



40 BRIGHT'S DISEASE. 

or organic system should be so impaired 
that it cannot perform its office, which is 
the elimination of the products of waste, 
through the excretory organs and of nutri- 
tion, the spinal cord and brain must corre- 
spondingly suffer. The mutual relation exist- 
ing between the different systems, is brought 
about by the mingling of the nerves, which 
so completely anastomose with each other 
that it is impossible to separate them by the 
nicest dissection. Paradoxical as it may 
appear, they are separated yet united. The 
nerves that concern us the most are the 
lesser splanchnic and solar plexus, both of 
which belong to the organic nervous system, 
and are those which control the functions of 
the kidneys. The nerves that are distributed 
to the small arteries and capillaries are the 
vaso-motor, and their office is to give "tone" 
to these vessels. They act upon the muscu- 
lar fibres of the arteries and capillaries, 
dilating or contracting them according to 
the stimulus imparted. If we divide the 
splanchnic nerve, the blood-vessels of the 
abdominal viscera become dilated, causing 
congestion. If a stimulus be applied to 
the same nerve, the same blood-vessels 



THE ORGANIC SYSTEM. 41 

become contracted. These vaso-motor 
nerves come from the splanchnic which is 
a compound nerve, consisting of nerve-fibres 
from the sympathetic and spinal nervous 
systems. The vaso-motor nerves control the 
function of the Malpighian bodies. The 
nerves from the solar plexus, which is chiefly 
a sympathetic nerve, are distributed to the 
uriniferous tubes and control their function. 
We thus have two sets of nerves distributed 
to the kidneys, possessing different func- 
tions, one to control the elimination of the 
watery portion of the urine and the other 
the solid constituents of the same. 

The Sympathetic or Organic Nervous 
System. 
Authors have assigned different names to 
this division of the nervous system. It has 
been called the " sympathetic nervous sys- 
tem," the " ganglionic nervous system," 
the " system of organic life," and the " sys- 
tem of vegetable life." We prefer the name 
" organic," on account of its being the seat 
of energy that unfolds the organism and sus- 
tains it during its physical existence. In its 
most rudimentary form, it consists of simple 



42 BRIGHTS DISEASE. 

nerve granules ; in its highest develop- 
ment, of nerve cells, which aggregated 
together form numerous ganglia. It con- 
sists of a series of ganglia united together 
by connecting nerve branches. There are, 
also, nerves leading from the ganglia to all 
parts of the organism ; associated with these 
are nerves from the cerebro-spinal system ; 
the interlacing of these nerves form what 
are called a plexus of nerves. The nerve 
fibres arising in the ganglia, according to 
Beale, surround the ganglionic cells in a 
spiral form [Fig. 8.] ; according to Arnold, 
they penetrate the cells and are attached to 
the nuclei, the seat of energy. They evi- 
dently enter the cells, which are very minute, 
being from I- 1200th to 1 -2000th of an inch 
in diameter, in order to receive energy. The 
origin of this nervous system is differently 
described by anatomists ; some believe it 
commences in the brain, others in the lower, 
or coccygial, or sacral region ; others believe 
it arises in the spinal cord. As its function 
is separate and distinct from the cerebro- 
spinal system, its source cannot be consis- 
tently assigned to brain or cord. Davey 
believes it to arise from the solar plexus, 



THE ORGANIC SYSTEM. 43 

which he designates as the sun and centre 
of the sympathetic nervous system; but, as 
this is merely a plexus of nerves and not a 
centre of nerve energy, it cannot be the 
source of a system. 

The semi-lunar ganglion, which lies imme- 
diately below the diaphragm and behind the 
stomach, is the centre. To describe this sys- 
tem intelligently : The ganglia are arranged 
in an oval form, one extremity in the brain, 
the other in the sacral region, and the centre of 
this oval is the semi-lunar ganglion. Besides 
this central ganglion there are six single and 
twenty-four double ganglia, the former being 
located in the cranium are called cranial 
ganglia. They consist of the ganglia of 
Ribes, the ganglia of Laumonier, the lenti- 
cular, the phrenopalatine, the otic, and the 
sub-maxillary ganglia. The twenty-four 
pairs are called the spinal ganglia, on ac- 
count of their lying along the spinal 
column. They are anatomically divided 
into three servical, twelve thoracic, four lum- 
bar and five sacral 'ganglia. The semi-lunar 
ganglion is also double, the right being larger 
than the left ; it is lobulated which gives it 
the appearance of a series of ganglia aggre- 



44 BRIGHT'S DISEASE. 

gated together and presenting a cribiform 
appearance. From the upper portion of the 
semi-lunar ganglion arises a number of nerves 
which unite with nerves from the 6th, 7th, 
8th, 9th and 10th dorsal ganglia of the same 
system, and form the great splanchnic 
nerve. From the lower portion of the semi- 
lunar ganglion are given off a number of 
nerves, which, from their arrangement, have 
been compared to the rays of the sun. These 
interlace and form the semi-lunar plexus. 
Anastomosing with this plexus of nerves 
are branches of the pneumo-gastric nerve 
and spinal cord. We will thus perceive 
that the sympathetic or organic nervous 
system consists of a series of ganglia, ex- 
tending from the brain to the sacrum, the 
centre of which is the semi-lunar ganglion. 
Each abdominal organ has assigned it a 
special ganglion from which it is named ; the 
one assigned to the kidneys is the renal gang- 
lion, to the liver the hepatic, to the spleen 
the splenic, to the heart the cardiac, to 
stomach the gastric, etc., etc. To each one 
is assigned the special function of the organ 
to which it belongs, the semi-lunar being 
the co-ordinating centre. 



THE ORGANIC SYSTEM. 45 

Function of the Organic Nervous 
System. — In man and the higher animals 
we have two distinct nervous systems; one 
organic or sympathetic to which is assigned 
organic life; the other the cerebro-spinal 
directing animal life. It is the former 
that concerns us on occount of being the 
seat of vital energy that unfolds the physical 
organism from the germinal cell and sustains 
it through its natural life. It is alluded to 
by some of the older writers, particularly 
Hippocrates, Aristotle and Plato, as the life 
principle manifested in organic forms. Aris- 
totle and Plato were the first to speak of it 
as the basis or groundwork, in studying the 
functions of the human organism. Serres 
alluding to the researches of Aristotle and 
Galen, states, "the method of Aristotle is 
essentially descriptive, neglecting the func- 
tion for the form. That of Galen essentially 
natural, neglecting the form for the function. 
The first of these methods carried in its 
train the descriptive sciences. The second 
led to the general sciences. The truth 
thus lay in their combination and to Haller 
we owe the merit of having first discovered 
this fact. He founded his arguments and 



46 BRIGHT'S DISEASE. 

opinions upon form and function combined, 
thus embracing in his method the descrip- 
tive as well as general sciences." Among 
the more modern investigators of the organic 
life principle stands Harvey, who, quoting 
Moses as authority, locates "the life of the 
flesh in the blood, for it is the life of the 
flesh." The inspired writer was right so far 
as he expresses it, for the blood possesses 
vitality which is derived from the organic 
nervous system. Bichat was the first to 
bring the subject of vital energy out of 
chaos. He claimed that the vital pheno- 
mena were of two kinds, one corresponding 
to those functions by which nutrition and 
growth of individuals are produced, and the 
other the reproduction of species — both 
Common to all living beings — phenomena 
which bring into existence living forms 
and sustain them during physical existence. 
To Bichat also belongs the credit of origi- 
nating the idea of the independent existence 
of the organic nervous system. Since his 
day, similar views have been advanced by 
Broussais, Gall, Richerand, Wertzer, and 
Fletcher of Edinburgh. Previous to the 
publication of Bichat's treatise on the sub- 



THE ORGANIC SYSTEM. 47 

ject of life and death, it was generally sup- 
posed that the entire nervous system was 
one uniform system. It was from the 
experiments of Dr. Marshall Hall, that it 
was fully established that there were three 
distinct nervous systems, viz. : The brain, 
spinal cord, and organic or sympathetic. It 
is somewhat remarkable that Carpenter, 
Mliller, Todd and Bowman have but little 
to say about the function of the last named 
system. This reticence has led to an indif- 
ference among physicians to the study of the 
functions of this system in connection with 
morbid, functional and structural changes 
in the human organism. It is a well estab- 
lished fact, with many physiologists and 
physicians of the present day that the 
organic nervous system controls nutrition 
by which the human organism is built up 
and subsequently sustained. It also con- 
trols the elimination of disintegrated pro- 
ducts from the system. 

Is the energy of the organic system vital 
or physical? It is generally held to be 
the former. The food used as nourish- 
ment when first received is dead matter, the 
energy that combines the molecules being 



48 BRIGHT'S DISEASE. 

purely physical. During the process of 
nutrition it has life imparted to it by the 
vital energy of the organic nervous system. 
If this energy be not imparted, it remains 
crude, lifeless matter, and will be eliminated 
by the excretory organs, the same as disin- 
tegrated matter. Every intelligent physi- 
cian knows that when the vital forces are 
depressed, the system cannot be properly 
nourished. In convalescence from a pro- 
tracted disease, if food be taken that is not 
digested and assimilated, the patient cannot 
be restored to health. Restore the vital 
energy and administer food sparingly, and 
the patient will gradually recover. It has 
baffled the penetration of physiologists and 
physicians to comprehend the nature of the 
vital principle. Various names have been 
given to it. Hunter calls it, "materia vitce 
diffusa;" Hippocrates, "impetum faciens ;" 
Van Helmont, " archceus ;" Stahl, "amma" 
The vis medicatrix, or vital principle, is 
evidently different from the physical energy, 
being governed by different laws, and mani- 
festing itself differently in the physical 
organism. To give a detailed view of its 
character and source, would require more 



THE ORGANIC SYSTEM. 49 

space than is allotted us in this work. We 
will therefore be compelled to treat it as 
briefly as possible to be understood. It lies 
back of the physical, and we must therefore 
delve into the realms of the unknowable, or 
unseen universe, where we must study 
energy and matter in their primitive condi- 
tions, and trace them from thence to the 
external world or visible universe. The 
more nature is studied the less complex 
she presents herself to our senses, and we 
are astonished to find how few and simple 
are her forces and her laws. Simplicity and 
concentration of purpose appear to be the 
peculiar features of the all-wise Being in the 
unfoldment of creation by His will. Com- 
plexity results from the differentiation of 
forms by the change of matter from an 
atomic to a molecular condition. Primary 
matter, which we call substance (to distin- 
guish it from physical matter), in its *chaotic 
state, was motionless, unatomic, without 
form and void, and therefore engulphed in 
impenetrable darkness. Incorporated with 
it were two latent energies, one seeking 
repose in the centre, the other activity at 
the periphery, called respectively by the 
4 



50 BRIGHT'S DISEASE. 

ancients, " attractive power" and "repelling 
motion!' Before motion, light and life made 
their appearance, or became manifest, these 
two were brought into juxtaposition by 
Deity, creating the law of Harmony, when 
He ordered light to appear. 

By bringing these energies together the 
substance of chaos was broken up into atoms, 
and, by the antagonism of the forces, motion 
was produced, and with it light and life. 
The atomic substance formed out of the chaotic 
matter by the antagonism of the twofold force 
enforced by the law of harmony, and guided by 
the Divine Will, constituted the beginning of 
creation. This substance constitutes the mat- 
ter of the subjective wx>rld out of which the 
soul is formed; the atomic substance or first 
matter uniting into molecules constitutes 
physical matter ; this change in substance 
is caused by the law of harmony yielding or 
relaxing to what we term equilibrium, les- 
sening the energy of the atoms as well as 
the light manifested by that energy, and 
thus changing it from an imponderable sub- 
stance to a ponderable matter, and with it the 
forces become secondary. This brings us to 
the objective world with its matter, force, 



THE ORGANIC SYSTEM. 51 

and equilibrating law. The forces and mat- 
ter of the two worlds are distinct, which is 
entirely owing to the law of harmony becom- 
ing modified. The conservation of matter 
and of force, which is a peculiar feature of 
this world, cannot be carried into the sub- 
jective, the conservation of substance and of 
energy of the subjective world cannot be 
carried into the objective ; but the subjective 
forces correlate with the objective forces of 
organic matter. 

In order to make this subject clear to the 
reader: There was but one original matter 
which we call substance and from which all 
matter is derived. There is but one energy in 
nature, which is twofold, from which all en- 
ergy is derived ; there is but one law in nature 
from which all lazv is derived that governs 
this energy. Light and heat are not forces, 
but resultants of force. All objective forces, 
so called by scientists and physicists, are 
but one force modified by the law of equi- 
libration. Magnetism, cohesion and chemi- 
cal affinity, regarded by scientists as three 
distinct forces, are but one force of a two- 
fold character in equilibrium. Electricity is 
the same out of equilibrium ; light is not 



52 BRIGHT'S DISEASE. 

visible to the physical eye, it can only be 
manifested in the simple atomic matter of 
which the soul is formed. The physical eye 
only recognizes fire-light, called by the an- 
cients the " fire-flash!' If the world is ever 
destroyed it must be by Deity suspending 
the law of harmony ; if this law should be 
suspended one moment all cosmical bodies 
would, in the twinkling of an eye, pass back 
into chaos. If the reader has been able to 
follow us, he will perceive that the vital force 
is purely subjective and unfolds the soul 
from primary substance, while the physical 
energy, correlating with the vital, unfolds the 
physical body. Man thus is a threefold 
being, a spirit self-encased in the soul and 
a soul encased in the physical body — and 
life consists in the correlating of the force 
of the soul and the organic force of the 
physical body. Now, we will submit the 
question : What is the vital energy of the 
physical organism ? It is the energy of the 
soul correlating with the energy of the nerv- 
ous system, the former directing the unfold- 
ment of the physical organism in accord- 
ance with the type and form of the soul, 
the physical body being the outward form 



THE ORGANIC SYSTEM. 53 

of the man — the external expression of a 
spiritual organism. This makes the physi- 
cal forces of organic matter subordinate to 
the vital, and the energy sustaining physical 
life a nervo-vital force. At death, the 
latter withdraws, correlation has ceased, and 
the physical takes possession of the organic 
matter and reduces it to its normal chemi- 
cal constituents. The correlation of the 
vital and physical forces takes place in the 
nervous system ; so long as harmony exists 
between them there is normal life-action. 
When discord exists we have disease which 
may be of a structural or functional charac- 
ter. The nervous system is the physical 
medium through which the spirit and soul 
communicate with the external world. The 
brain is devoted to psychical, emotional, sen- 
sational properties of the spirit, and the or- 
ganic nervous system to growth, repair and 
elimination of waste from the organism. 

What is disease ? It is an impairment or 
ennervation of the nervo-vital energies, oper- , 
ating in and through the organic or sympa- 
thetic nervous system, leading to functional 
derangement or structural changes in the 
organism. The cause of impairment of 



54 BRIGHT'S DISEASE. 

physical health is not dependent upon relax- 
ing of the soul's energy, but on the disturb- 
ance of the correlation of the nervo-vital 
forces. The physical organism is merely a 
dwelling-place for the soul during the spirit's 
individualization in matter and spiritual pro- 
bation. The period assigned for man's 
spiritual probation is three score and ten 
years ; yet how few attain to it, owing to 
heriditary and acquired causes, impairing the 
organic nervous system and its energies, 
and thus preventing the Spirit from sustaining 
physical life. We shall fully elaborate this 
subject in a work we are now preparing for 
the press, entitled, Life, What itis y Its Source 
and How it may be Prolonged. 



CHAPTER III. 

Function or Office of the Kidneys. 

The office of the kidneys is to eliminate 
some of the morbid products of the blood, 
the result of disintegration, which is 
momentarily taking place in the physical 
organism. The arteries convey the blood 
to the capillaries to supply the waste that 
is taking place in the system. The veins 
receive from the capillaries the blood which 
contains the product of decay, and convey 
it to the different eliminating organs, where 
it is thrown off. The scavengers or puri- 
fiers of the blood are the kidneys, lungs, 
liver, the glands of the alimentary canal 
and skin. The capillaries are thus the car- 
riers of the blood to the various tissues and 
organs, to supply the waste that is continu- 
ally occurring, and they also take up the 
products of decay and convey them with the 
blood to the veins. The office of the kid- 
neys is to eliminate the azotized or nitro- 
genized products; the liver the carbo-hy- 
drogen, and the lungs carbonic acid. If 

55 



56 BRIGHT'S DISEASE. 

these decayed elements should be retained 
in the blood a short time, they poison the 
nervous centres, and cause death. It is 
therefore of the utmost importance that the 
eliminating organs should be in a healthy 
and active condition, to cleanse the blood 
of these morbid products. The great secret 
of health is to take into the system suf- 
ficient food, and no more, to compensate 
for the waste, and to keep the excretory or- 
gans in a healthy condition, to remove the 
impurities from the blood. If we could 
maintain this balance (in a normal or healthy 
constitution) between repair and waste, and 
not overtax our vital energies, there would 
be no difficulty in attaining to the age alot- 
ted to man, if not going considerably beyond 
it. In order to understand the functions of 
the kidneys, it will be necessary for us to 
familiarize ourselves with the structure, 
which we have fully described in a previous 
chapter. It is in the Malpighian tufts and 
uriniferous tubes of the cortical portion of 
the kidney where this function is performed. 
Dr. Bowman in an essay, published in 1842, 
was the first to advance a true theory of 
the function of this portion of the kidney. 



OFFICE OR FUNCTION. 57 

On account of the clearness with which he 
has presented this subject, we think it ad- 
visable to quote him : — 

" Reflecting on this remarkable structure 
of the Malpighian bodies, and their singular 
connection with the tubes, I was led to 
speculate on their use. It occurred to me 
that as the tubes and their plexus of capil- 
laries were probably, for reasons presently 
to be stated, the parts concerned in the se- 
cretion of that part of the urine to which its 
characteristic properties are due (the urea, 
lithic acid, etc.), the Malpighian bodies 
might be an apparatus destined to separate 
from the blood the watery portion. This 
view, on further consideration, appears so 
consonant with facts, and with analogy, 
that I shall in a few words state the reasons 
that have induced me to adopt it. I am 
not unaware how obscure are the regions 
cf hypothesis m physiology, and shall be 
most ready to renounce my opinion if it 
should be shown to be inconsistent with 
truth. 

" In extent of surface, external structure, 
and the nature of its vascular net-work, the 
membrane of the uriniferous tubes corre- 



58 BRIGHT'S DISEASE. 

sponds with that forming the secreting sur- 
face of other glands. Hence it seems cer- 
tain that this membrane is the part specially 
concerned in eliminating from the blood the 
peculiar principles found in the. urine. To 
establish this analogy, and the conclusions 
deduced from it, a few words will suffice: 
I. The extent of surface obtained by the in- 
volution of this membrane will by most be 
regarded as its self-sufficient proof. 2. Its 
internal surface is conclusive. Since epi- 
thelium has been found by Purkinje and 
Henle in such enormous quantities on the 
secreting surface of all true glands, its use 
cannot be considered doubtful. It never 
forms less than I9~20ths of the thickness of 
secreting membrane, and in the liver it even 
seems to compose it entirely, for there I 
have searched in vain for a basement tissue 
like that which supports the epithelium in 
other glands. The epithelium, thus chiefly 
forming the substance of secreting mem- 
brane, differs in its general characters from 
other forms of this structure. Its nucleated 
particles are more bulky, and appear from 
their refractive properties to contain more 
substance, their internal tissue being very 



OFFICE OR FUNCTION. 59 

finely mottled when, seen by transmitted 
light. In these particles the epithelium of 
the kidney tubes is eminently allied to the 
best marked examples of glandular epi- 
thelium. 3. The capillary net-work surround- 
ing the uriniferous tubes is the counterpart 
of that investing the tubes of the testes, 
allowance being made for the difference in 
the capacity of these canals in the two 
glands. It corresponds with that of all true 
glands in lying on the deep surface of the 
secreting membrane, and its numerous ves- 
sels everywhere anastomosing freely with 
one another. 

"These several points of identity may 
seem too obvious to be dwelt upon, but I 
have detailed them in order to show that, 
in all these respects, the Malpighian bodies 
differ from the secreting parts of true 
glands. 1. The Malpighian bodies com- 
prise but a small part of the inner surface 
of the kidney, there being but one to each 
tortuous tube. 2. The epithelium immedi- 
ately changes its character as the tube 
expands to embrace the tuft of vessels. From 
being opaque and minutely mottled, it 
becomes transparent, and assumes a definite 



60 BRIGHT'S DISEASE. 

outline; from being bald it becomes covered 
with cilia (at least in reptiles, and probably 
in all classes) ; and in many cases it appears 
to cease entirely a short way within the 
neck of the Malpighian corpuscle. 3. The 
blood-vessels instead of being on the deep 
surface of the membrane, pass through it, 
and form a tuft on its free surface. Instead 
of the free anastomoses elsewhere observed, 
neighboring tufts never communicate, and 
even the branchlets of the same tuft remain 
quite isolated from one another. 

"Thus the Malpighian bodies are as 
unlike, as the tubes passing from them are 
like, the membrane which, in other glands, 
secern its several characteristic products 
from the blood. To these bodies, there- 
fore, some other and distinct function is 
with the highest probability to be attri- 
buted. 

" When the Malpighian bodies were con- 
sidered merely as convoluted vessels, with- 
out any connection with the uriniferous 
tubes, no other office could be assigned 
them than that of delaying the blood in its 
course to the capillaries of the tubes, and 
the object of this it was impossible to ascer- 



OFFICE OR FUNCTION. 61 

tain. Now, however, that it is proved that 
each one is situated at the remotest ex- 
tremity of the tube, that the tufts of the 
vessels are a distinct system of capillaries 
inserted into the interior of the tube, sur- 
rounded by a capsule formed by its mem- 
brane, and closed everywhere except at the 
orifice of the tube, it is evident that conjec- 
tures on their use may be formed with 
greater plausibility. 

" The peculiar arrangement of the vessels 
in the Malpighian tufts is clearly designed 
to produce a retardation in the flow of blood 
through them, and the insertion of the tuft 
into the extremity of the tube is a plain 
indication that this delay is subservient in a 
direct manner to some part of the secretive 
process. 

" It now becomes interesting to inquire, 
in what respect the secretion of the kidney 
differs from that of all other glands, that 
so anomalous an apparatus should be 
appended to its secreting tubes. The differ- 
ence seems obviously to lie in the quantity 
of aqueous particles contained in it, for how 
peculiar soever to the kidney the proximate 
principles of the urine may be, they are not 



62 BRIGHT'S DISEASE. 

more so than those of other glands to the 
organs which furnish them. 

" This abundance of water is apparently- 
intended to serve chiefly as a menstruum 
for the proximate principles and salts which 
this secretion contains, and which, speaking 
generally, are far less soluble than those of 
any other animal product. This is so true, 
that it is common for healthy urine to 
deposit some part of its dissolved contents 
on cooling. 

" If this view of the share taken by the 
water be correct, we must suppose that 
fluid to be separated either at one point of 
the secreting surface along the proximate 
principles, as has hitherto been imagined, 
or else in such a situation that it may at 
once freely irrigate the whole extent of the 
secerning membrane. Analogy lends no 
countenance to the former supposition; 
while to the latter, the singular position and 
all the details of the structure of the Mal- 
pighian bodies, gives strong credibility. 

" It would, indeed, be difficult to conceive 
a disposition of parts more calculated to 
favor the escape of water from the blood 
than that of the Malpighian body. A large 



OFFICE OR FUNCTION. 63 

artery breaks up, in a very direct manner, 
into a number of minute branches, each of 
which suddenly opens into an assemblage 
of vessels of far greater aggregate capacity 
than itself, and from which there is but one 
narrow exit. Hence must arise a very ab- 
rupt retardation in the velocity of the cur- 
rent of blood. The vessels in which this 
delay occurs are uncovered by any struc- 
ture. They lie bare in a cell from which 
there is but one outlet, the orifice of the tube. 
This orifice is encircled by cilia in active 
motion, directing the current to the tube. 
These exquisite organs must not only serve 
to carry forward the fluid already in the 
cell, and in which the vascular tube is 
bathed, but must tend to remove pressure 
from the free surface of the vessels, and so 
to encourage the escape of their more fluid 
contents. Why is so wonderful an appara- 
tus placed at the extremity of each urinife- 
rous tube, if not to furnish water to aid in 
the suppuration and solution of the urinous 
products from the epithelium of the tube ?" 
The theory advanced by Dr. Bowman 
that the uriniferous tubes secrete the solid 
constituents of the urine, is verified by ex- 



64 BRIGHT'S DISEASE. 

amining the urine of the boa y which is 
almost solid. The solidity of the urine of 
the boa is owing to the artery supplying the 
kidneys being very small compared with 
other animals, and eliminating but a very 
small quantity of water, barely sufficient to 
carry off the solid material secreted by the 
tubes. Observations made by Dr. Johnson 
are also confirmatory of Dr. Bowman's 
theory. He states : " In examining the kid- 
neys of a person who died with jaundice, 
and in whose urine there had been a large 
quantity of bile, I observed that the tubes 
were stained of the deep yellow color of bile 
in their epithelial cells, and that the yellow 
color ceased absolutely at the neck of the 
Malpighian corpuscle, and in no one instance 
did it affect any part of the tissues of the 
Malpighian bodies." We may therefore 
conclude, without further testimony from 
the observations of Dr. Bowman and the 
confirmation of modern physiologists, that 
the solid constituents of the urine are 
secreted by the uriniferous tubes of the kid- 
neys. The straight portion of the tubes of 
the pyramid have no secreting power as- 
signed them, although they are lined by the 



OFFICE OR FUNCTION. 65 

same character of epithelium as the cortical 
portion. They are merely excretory ducts 
for the purpose of conveying off the excre- 
tory products of the tortuous portion of the 
tubes and the water eliminated by the Mal- 
pighian bodies into the pelvis of the kidneys. 
The kidneys perform another important 
office in the human economy, besides elimi- 
nating nitrogenized products. They act as 
a safety-valve in regulating the quantity of 
water in the blood. They, with the lungs 
and skin, are the only means through which 
the system has the power of removing the 
water from the blood. The amount of fluid 
that passes off in the form of insensible 
perspiration and by the lungs, according to 
Seguin, is eighteen grains per minute, eleven 
grains of which is thrown off by the skin 
and seven grains by the lungs. The maxi- 
mum quantity eliminated by the skin and 
lungs in twenty-four hours is five pounds, 
and the minimum quantity, one pound and 
two-thirds. The exhalation of the skin 
varies according to the condition of the 
atmosphere ; when it is moist, it is dimin- 
ished, when dry, it is increased. When the 
temperature is high and the atmosphere dry, 
5 



66 BRIGHT'S DISEASE. 

a large amount of moisture is thrown off 
in the form of sensible perspiration, and 
with it there escapes a large amount of free 
caloric relieving the system from oppression 
which might otherwise occur. We are all 
aware of the relief free perspiration affords 
in extremely warm weather, and how soon 
a simple fever may be broken up by induc- 
ing a copious perspiration. For many 
years, I have been in the habit of breaking 
up catarrhal and remittent fevers by bring- 
ing about a free perspiration and keeping it 
up until the fever subsides, which it will 
usually do in from six to twenty-four hours. 
In this plan of treatment the head should 
always be kept cool by the application of 
ice. 

Several years ago, when the relapsing- 
fever prevailed in Philadelphia, the crisis 
was brought about on the seventh day by 
Nature causing the patient to perspire co- 
piously, and the kidneys to act freely. If 
the first attack, the patient would be appa- 
rently well and out in from twenty-four to 
forty-eight hours, to be again stricken 
on the seventh day, with the symtoms 
aggravated, and when repeated the third time, 



PERSPIRATION. 67 

it was generally fatal. After losing one 
case during the third attack, I anticipated Na- 
ture by producing at the commencement of 
the disease a copious perspiration, and keep- 
ing it up for forty-eight hours. I never lost 
a case afterwards, neither did I have any cases 
to relapse. It is by perspiration of the skin 
that we get rid of the free caloric, which, if 
retained, brings about congestion of some 
one of the internal organs. What is com- 
monly known as coupe de soldi, or sunstroke, 
is the overheating of the blood, producing 
cerebral congestion. We thus perceive the 
danger of suddenly checking perspiration, 
which is frequently and ignorantly done by 
sitting in a draught, or by removing superflu- 
ous clothing, when overheated. The blood- 
vessels of the skin become contracted by sud- 
den change of temperature, forcing as uper- 
abundance of blood upon the kidneys or 
lungs, etc., causing congestion. Most per- 
sons are aware that less water is passed by 
the kidneys in summer than in winter. This 
is owing to the blood-vessels becoming 
contracted, and perspiration lessened, caus- 
ing the blood to be directed toward the 
kidneys, producing a more rapid discharge 



68 BRIGHT'S DISEASE. 

of water from the Malpighian bodies. Per- 
sons affected with Bright's Disease should 
be exceedingly careful to protect the sur- 
face of the body in summer as well as in 
winter, for fear of increasing congestion of 
the urinary organs, which always attends 
Bright's Disease. Cutaneous perspiration 
has no influence on the amount of solid 
matter secreted by the kidneys ; it depends 
upon the waste taking place in the system, 
and the excess of food taken to supply the 
wants of nutrition. When there is too much 
to compensate for the waste, the excess 
is not assimilated, but undergoes rapid 
retrograde metamorphosis, and must be 
eliminated by some one of the excretory 
organs. It is by excess of feeding, and 
the drinking of spirituous liquors, that the 
gormandizer and inebriate overtax the 
liver and kidneys, producing either organic 
or functional disease, and leading to much 
suffering, if not to premature death. 

Under ordinary circumstances, each ex- 
cretory organ is limited to its own special 
function, yet there are certain complementary 
relations between them which enable them 
to render assistance to each other. For 



VICARIOUS EXCRETIONS' 



69 



example, when respiration is active, the 
lungs eliminate more carbonic acid, and the 
liver secretes less bile, it consisting largely 
of carbon. If respiration be diminished, 
there is less carbon thrown off by the 
lungs, which is eliminated with hydrogen, 
in the form of bile. We find similar com- 
plementary relations existing between the 
skin and the kidneys, to which w T e have 
already alluded. While speaking of the 
mutual relations existing between the dif- 
ferent organs, it will not be out of place to 
allude to what are called vicarious excre- 
tions. It is the metastasis or removal of an ex- 
cretion from its natural outlet through some 
organ possessing entirely different func- 
tion. For example, urine has been known 
to have been eliminated from the bowels, 
eyes, breast (of the female), stomach, mouth, 
nose, ears, skin, etc. Dr. Lacock has col- 
lected a large number of such cases, which 
we give in the following table : — 



124 



A familiar form of excretory metastasis is 



"3 


*o 


ifl 


w 


ci 


<u 


C/5 


> 


c 




> 




& 









52! 


M 


£ 


01 


33 


20 


4 


4 


5 


3 


4 


34 


17 



70 BRIGHT'S DISEASE. 

found in jaundice, where the bile is secreted 
by the liver, absorbed in the blood, and 
eliminated by the skin, kidneys, etc. 

Secretion of Urine. — To understand 
the morbid condition of the urinary organs, 
we must be familiar with their normal func- 
tions. Fresh, healthy urine is a clear, am- 
ber yellow liquid, and of a peculiar, dis- 
agreeable odor, with a well marked acid 
reaction. If permitted to stand some time 
a slight cloudiness appears, consisting of 
mucus, which gradually settles at the bot- 
tom of the vessel. Very soon a different, 
more unpleasant odor is developed, when 
the urine becomes alkaline, which is owing 
to the decomposition of urea into carbonate 
of ammonia, and a precipitate of earthy 
phosphates. 

Healthy urine may become turbid soon 
after being passed, on cooling, which is due 
to the precipitation of urates of soda and 
ammonia, which are very soluble in warm 
water, but insoluble in cold water. It is 
only when they are slightly in excess that 
they are precipitated. If the urine should be 
turbid 07t passing it is considered abnormal. 
The quantity of urine passed in twenty-four 



AMOUNT OF URINE. 71 

hours varies, depending upon the amount 
of liquid taken into the system, and the ex- 
ternal temperature. If the surface of the 
body should be chilled, and perspiration 
become partially checked, there is more 
water passed by the kidneys. According 
to the observations of Dr. Prout, about 
30 ounces is the amount passed in summer, 
and 40 ounces in winter. The specific grav- 
ity of urine varies with the amount of solid 
food taken, and the amount of waste going 
on in the organism. The average, taking 
the whole year, according to the same 
writer, is about 1020, rising in summer to 
1025, and falling in winter to 1015. This 
variation, as we have previously stated, is 
owing to the much larger amount of fluid 
eliminated by the skin during the warm 
summer months in the form of perspiration 
than during the cold, chilly months of fall, 
winter and spring. 

The amount of solid matter in 1000 parts 
of urine fluctuates widely, the difference 
being due to diet, waste taking place in the 
system, and the amount of water eliminated. 

The following tables have been construc- 
ted by Simon, from Leeman's Analysis: 



72 



BRIGHT'S DISEASE. 



Urine. 



Amount in 24 Hours . . . 

Specific Gravity 

Solid Residuum from 1000 Parts 

of Urine Passed .... 
Solid Matter Passed in 24 

Hours 



Mixed 
Diet. 



IO57.8 
I022. 

65.82 
67.82 



Animal 
Diet. 



Grammes. 

I202.5 

IO27.I 

7548 
87.44 



Vegeta- 
ble Diet. 



Grammes. 

909. 

IO27.5 

66.4I 

59-23 



Urea. 


In 100 parts of 
solid residuum. 


Daily amount 
in grammes. 


During a mixed diet, . . 
During an animal diet, 
During a vegetable diet, . 


46.230 
61.297 
39.086 


32.498 
53.198 
22.481 



Uric Acid. 


In 100 parts of 
solid residuum. 


Daily amount 
in grammes. 


During a mixed diet, . 
During an animal diet, . 
During a vegetable diet, . 


1. 7IO 

I.674 

^•737 


1. 183 
1.478 
I.02I 



It will be observed from these tables that 
the amount of urea is always diminished 
by vegetable diet, while the quantity of 
uric acid is not materially affected. A 
knowledge of this fact is of the utmost im- 
portance in the treatment of Bright's Dis- 
ease. Vegetable diet considerably increases 
the amount of extractive matter, which is 
diminished in animal diet. The amount of 



*A gramme is equal to 15.4 grains Troy. 



CONSTITUENTS. 



73 



phosphates, lactic acid and lactates are but 
slightly changed by an animal or mixed 
diet. 



Constituents. 



Solid constituents, . 

Urea, 

Uric Acid, . . . 
Lactic Acid and Lactates, 
Extractive matters, . 









Grammes 


Grammes 


Grammes 


67.82 


8744 


59.24 


32.5O 


53 20 


22.48 


I.I8 


I.48 


I.02 


2.72 


2.17 


2.68 


IO.49 


5.20 


16,50 



fc=a 



Gr mes 
44.68 
15.41 
0.73 

5.82 

11.85 



We observe that urine consists of a 
liquid and solids, which are produced by 
two distinct structures, but closely united. 
They comprise the Malpighian bodies and 
uriniferous tubes, the functions of which we 
will speak of separately. 

1 . Malpighian Bodies. — The Malpighian 
tufts or glomerules consist of capillaries 
twisted upon themselves, forming a round 
mass or ball, and enclosed within the upper 
and dilated portions of the uriniferous tubes 
[Figs. 3 and 4]. These capillary vessels are 
minute tubes lying between the arteries and 
veins, and so numerous that it would be im- 
possible to insert the point of a needle in 



74 BRIGHT'S DISEASE. 

any part of the soft tissues without injuring 
them. It will not be amiss here to state, 
briefly, the relation existing between the 
capillaries, arteries and veins. The arteries 
arise from the ventricles of the heart in two 
branches, one going to the lungs, and called 
the pulmonary artery, the other to the gen- 
eral system, called the aorta. They divide 
and subdivide, and finally terminate in 
capillaries. The veins arise from the capil- 
laries and convey the blood back to the 
heart ; the capillaries are, therefore, a con- 
necting link between the arteries and veins. 
All of these vessels have elastic walls, con- 
sisting of muscular fibres and muscular cells, 
which are well defined in the large arteries, 
but gradually diminish as they emerge into 
the capillaries, whose walls are exceedingly 
thin and permeable, permitting the fluid por- 
tion of the blood to pass through them into 
the surrounding tissues or " lymph space." 
There is a normal constriction in the capillary 
walls which limits the amount of fluid passing 
through them. The area of the aorta is 
much less than the area of its branches. 
Vierodt has estimated the area of the capil- 
laries, and makes them several hundred 



RELATIONS OF NERVES. 75 

times larger than the area of the aorta. 
They may be compared to an inverted fun- 
nel, with its apex at the aorta. To the 
arteries and capillaries are distributed nerve 
fibres, called vaso-motor nerves. These 
nerves control the calibre of the capillaries, 
as we have shown in a previous chapter. If 
there is a deficiency of nerve-energy, the 
walls are relaxed, circulation sluggish, and 
the parts assume an increased redness. The 
emotions frequently bring about this condi- 
tion, producing what is called " blushing." 
The opposite condition takes place in what 
is called " palor." If the splanchnic nerve 
be divided, the walls of the capillaries sud- 
denly relax, followed by a copious filtering 
of water from the blood, as in hydrura or 
poly-urea. If a stimulus be applied to the 
divided nerve, the relaxation of the tufts is 
overcome and the copious flow ceases. An 
injury to the cerebellum will give rise to an 
increased flow of urine ; a puncture of the 
fourth ventricle of the brain or a mechanical 
injury to the fourth thoracic ganglion causes 
a large quantity of sugar to appear in the 
urine, with a rapid increase of fluid. This 
is known as artificial diabetes. Injuries to 



76 BRIGHT'S DISEASE. 

the pneumo-gastric or par-vagum nerve, or 
to the medulla oblongata cause a rapid flow 
of urine. These injuries impair the func- 
tion of the vaso-motor nerves, which are 
branches of the splanchnic nerve, containing 
motor fibres from the spinal cord. From 
what has been stated, it can readily be per- 
ceived that the vaso-motor nerves are spinal 
branches associated with sympathetic nerve 
branches, controlling capillary circulation, 
and, therefore, modifying the quantity and 
character of the water eliminated by the 
Malpighian tufts, which is not a secretion, 
but simply a filtration through the capillary 
walls. We have, then, two sets of nerves 
distributed to the kidneys : one vaso-motor, 
which are inhibitory and come from the 
spinal system, and yet are associated with the 
splanchnic nerve, a branch of the sympa- 
thetic, and nerves from the solar plexus 
which control the secretion of the urinife- 
rous tubes. It is believed, and so stated, 
by physiologists, that filtration depends 
upon arterial pressure. It may, to a limited 
extent. The arrangements of the capillaries 
in forming the glomerules is to economize 
space and give more filtering surface. In 



URINIFEROUS TUBES. 77 

the boa, the renal artery is very small, and 
the glomerules correspond in size with the ' 
artery. The vaso-motor nerves give tone to 
the walls of the capillaries, which a moder- 
ate irritation increases. If pushed too far, 
the nerve becomes exhausted and relaxation 
ensues, the tone is gone, and the filtration 
of water is increased. I am, therefore, of 
the opinion that arterial pressure does not 
facilitate filtration in the glomerules, but 
relaxation of the capillary walls, by a dimi- 
nution of vaso-motor energy, causes it. 

2. Uriniferons Tubes. — We have shown 
that the office of the Malpighian bodies is 
to eliminate the superabundance of water in 
the blood which is accomplished by a pro- 
cess of filtration through the walls of the 
capillary tufts; the quantity eliminated 
depending upon the tonicity of the walls, 
imparted by the vaso-motor energy. 

The function of the uriniferous tubes is 
very different from that of the Malpighian 
tufts, being performed by an epithelium 
structure resting on the basement mem- 
brane and lining the tubes. The office is 
one of excretion, and is a nervo-vital pro- 
cess, the energy being imparted through 



78 BRIGHT'S DISEASE. 

the solar plexus. In the kidneys there are 
two perfectly distinct systems of capillary 
vessels. The first consists of the Malpighian 
tufts which are immediately connected with 
the arteries. The second envelopes the 
uriniferous tubes, forming a plexus around 
the tubes and so arranged as to form a basis 
for the basement membrance of the tubes ; 
the capillaries then terminate in veins 
[Fig. 3]. We have already given a descrip- 
tion of this membrane in a previous chap- 
ter, and all that is necessary to say here, is 
that the material of which it is composed is 
an elimination from the capillaries, which, 
undergoing a vital change from energy 
imparted by the ganglionic nervous sys- 
tem, causes the exuded fluid to become 
granular. These granular particles unite 
to form the nuclei, and these possess the 
inherent vital energy to construct the epi- 
thelium cells that rest upon the basement 
membrane. Nerve fibres have been traced 
into this membrane, and are supposed to 
extend up into the epithelium cells and to 
be attached to the nuclei. This is not requi- 
site; the nerve fibres convey an energy to 
the blood lymph that is eliminated from the 



CELL CHANGES. 79 

capillaries, and in revitalizing it produce 
the granular particles which aggregate and 
form muclei, and the muclei possess the 
power to create cells. Therefore, all that 
is necessary is for the nerves to enter the 
fluid mass and create vitalizing centres, 
which are the granules. All secretory and 
excretory cells are frequently removed, for 
as soon as the cell contents are changed 
into the solid constituents of the urine the 
cell disintegrates and another immediately 
takes its place from the basement mem- 
brane. In all secreting and excreting 
organs, the formation and disintegration of 
cells depend upon the activity of the func- 
tions of the organ. In the stomach, during 
digestion and in the villi of the intestines 
during the absorption of chyle, the func- 
tions are exceedingly active, and the forma- 
tion and disintegration of cells is very rapid. 
The change of cells in the kidney tubes 
depends upon the amount of serum elimi- 
nated from the vessels, and the amount of 
nerve energy imparted to it. For example, 
in fevers and inflammatory condition of the 
kidneys both are increased, and a greater 
amount of solid constituents is excreted and 



80 BRIGHT'S DISEASE. 

therefore a more rapid formation and disin- 
tegration of cells must take place. If this 
vital nerve energy should be diminished, 
and less blood serum be eliminated, the 
specific gravity of the urine becomes les- 
sened, owing to a diminution of the solid 
constituents. We may regard all epithelium 
cells in any part of the system as small labora- 
tories and the work-master or chemist the 
nucleus. If the master be sick or out of 
sorts (and this will depend upon the condi- 
tion of the nervous system that gives him 
his energy) the work is imperfectly per- 
formed and the result, disease. In proof 
that the nervous system is the source of 
energy, by stimulating the nerve branches 
of a gland the secretion is rapidly increased 
and is much richer in constituents. If the 
nerve fibres be divided the secretion stops 
entirely, or becomes very fluid. We shall 
show when we speak of the cause of Bright's 
Disease, that in the organic nervous system 
lies the cause of this much dreaded and 
inveterate malady. If a solution of indigo- 
carmine be injected into the veins of the 
kidneys of an animal in which the urinary 
flow has been arrested by an incision of 



UNANSWERED QUESTION. 81 

the medulla oblongata, the carmine will be 
found to have passed through the walls of 
the capillaries, and been diffused through the 
basement membrane, taken up by the cells 
and eliminated into the tubes. No trace of 
it, however, can be found in the Malpighian 
tufts. This shows the method nature adopts 
for the elimination of morbid products from 
the blood which is accomplished through 
cell structure, resting upon and formed from 
a basement membrane. The uriniferous 
tubes are secretory glands, taking from the 
blood lymph, eliminated by the capillaries, 
the waste products and by nervo-vital 
chemistry changing them into urea, uric 
acid, extractive matter, etc. 

How are the disintegrated products of 
the tissues, which are so varied, distributed 
by the blood-vessels to the organs assigned 
. for their elimination ? For example, the 
kidneys take from the blood the nitrogenous 
products of waste, the liver the carbo-hydro- 
gen products of the same. This question 
has yet to be answered by physiologists. It 
is well known to the physician, that if tartar- 
emetic or ipecac be injected into the bowels 
or into the blood, it will produce nausea 



82 BRIGHT'S DISEASE. 

and vomiting as if taken into the stomach. 
If urea be introduced into the stomach or 
injected into the circulation, it makes its ap- 
pearance in the kidneys for elimination ; if 
Cantharides, turpentine, and the various 
balsams be taken into the system, they are 
likewise eliminated by the kidneys. The 
nervo-vital energy possesses the power of 
establishing affinities or sympathies in the 
excretory organs by w T hich they attract 
certain substances from the blood that, if 
retained, would be injurious to the system. 
It is upon this basis that homoeopathists 
prove their remedies. For example, in 
desiring to know the properties of a remedy, 
they give it to several persons in health 
unknown to each other; when symptoms 
are produced alike in all these provers, it 
shows that the remedy has a special affinity 
for certain parts of the system, and the 
symptoms that are produced in these parts 
are their guide in selecting the remedy when 
a diseased condition exists presenting simi- 
lar symptoms. Certain organs evince affini- 
ties for certain remedies, and these affinities 
are produced by the vital energy of the soul, 
correlating with the organic nerve-energy. 



CHAPTER IV. 

Abnormal Condition of the Kidneys in 
Bright's Disease. 

The structural changes that take place in 
Bright's Disease during its progress have 
been classified under different heads. Rein- 
hardt and Frerichs believe the disease results 
from inflammation of the kidneys, and have 
divided it into three stages ; I. The inflam- 
matory stage; 2. The exudation, in which 
is observed a fatty degeneration of the epi- 
thelium lining of the tubes and the glome- 
rules ; 3. Abnormal growth of the connect- 
ing tissues, terminating in atrophy. The 
German and French pathologists insist 
upon the unity of the disease ; the English 
pathologists, on the contrary, deny the 
unity, maintaining that the disease com- 
prises several distinct forms. They base 
their opinion on the cause, the symptoms, 
and the pathological changes that occur. 
Dr. Johnson, in his work on disease of 
the kidneys, published in 1852, and his 
lectures on the same subject, published in 

83 



84 BRIGHT'S DISEASE. 

1873, divides this disease into acute and 
chronic forms. The former represents the 
inflammatory stage, and the latter the 
pathological changes that occur during the 
progress of the disease. The first change, 
involving the epithelium lining of the urin- 
iferous tubes and the glomerules, constitutes 
the red granular kidney. When the paren- 
chymatous structure (the body of the kidney) 
becomes involved, we have the second 
stage of the disease; this constitutes the 
large, white kidney. When the organized 
tissues become absorbed, and atrophy takes 
place, it comprises the third stage, and is 
called the lardaceous or waxy kidney. 
Roberts, Dickson, Stewart, and others have 
somewhat modified the division of Johnson, 
without materially differing with him, or 
throwing light upon the subject. We 
therefore deem it unnecessary further to 
refer to these writers, as it will only confuse 
the reader, instead of enlightening him. 
There is no doubt but that Bright's Disease 
assumes two distinct forms, acute and 
chronic, as is the case with a large majority 
of diseases, providing the former is allowed 
to pursue its course. In the acute form 



ACUTE AND CHRONIC. 85 

there is a higher grade of inflammation, 
which is due to an active impairment of the 
nervo-vital energy of the vaso-motor nerves, 
causing a relaxation of capillary blood-ves- 
sels of the kidneys, and consequently an 
accumulation or superabundance of blood 
in the parts involved. Nature endeavors to 
overcome the nervous shock, and if she 
succeeds the acute stage subsides. If she 
only partially succeeds, inflammation be- 
comes somewhat lessened, and the disease 
gradually passes into what is called the 
chronic form. We cannot conceive why 
there should be a conflict of opinion between 
the English and Continental pathologists, 
for Bright's Disease, when it becomes mani- 
fested in the kidneys, and is allowed to con- 
tinue, causes various pathological changes. 
In the acute form it is more functional than 
organic, but if permitted to continue, the 
changes described by the English physi- 
cians occur. Yet it is one and the same 
disease. Although Bright's Disease is 
always accompanied by inflammation, the 
mere fact of inflammation does not consti- 
tute Bright's Disease. Inflammation is an 
ennervation of the vaso-motor nerves, per- 



86 BRIGHT'S DISEASE. 

mitting a relaxation of the capillaries, and 
causing an increased flow of blood to the 
parts, consequently an increased redness 
and oxidation, therefore an increase of tem- 
perature. All this may occur without the 
elimination of albumen, which is the charac- 
teristic feature of Bright's Disease. To pro- 
duce this inveterate complaint something 
more than inflammation must exist. In 
Brighfs Disease we have not only an enner- 
vation of the vaso-motor nerves (the cause of 
inflammation), but an ennervation of the 
nerves of the solar plexus, causing a change 
in the secretion of the cellular structure of the 
uriniferous tubes, and a change in the nutri- 
tion of the entire kidney, and this constitutes 
Brighfs Disease. We therefore are of the 
opinion that Bright's Disease assumes two 
distinct forms, acute and chronic, which we 
shall treat of separately. 

i. The Acute. — This form is not near so 
common as the chronic ; it occasionally 
follows the acute stages of scarlet fever, 
small-pox and diphtheria. In the first 
instance, it sets in about the end of the 
second week, and in cases where the erup- 
tion is not well defined, and is aggravated 



PATHOLOGICAL CHANGES. 87 

by exposure to cold and dampness. In 
small-pox, it occurs during the disquama- 
tion period, and in cases where the system 
has received a severe shock from the poison. 
In diphtheria, it makes its appearance in 
cases where the system is very much re- 
duced. The acute form occasionally occurs 
during pregnancy, but generally terminates 
with it. The vegetable and mineral poisons, 
and the too free use of alcoholic drinks, 
bring about a similar condition of the kid- 
neys. The pathological changes observed 
in the acute form are principally confined to 
the cortical portion of the kidneys. The 
Malpighian bodies present a dark-red ap- 
pearance ; their epithelium covering is more 
or less detached, and the capillary walls 
thickened. The epithelium lining of the 
tubes is more prominent and elevated, 
giving evidence of overgrowth. The tubes 
become choked with exuded epithelium 
cells mixed with more or less blood. The 
cells lining the tubes may be natural, but 
opaque, and disintegrate rapidly and are 
easily detached from the basementmembrane. 
There is an exudation in the form of 
transparent cylinders of various sizes in 



88 BRIGHT'S DISEASE. 

the tubes that have shed their epithelium. 
These abnormal changes seriously impair 
the function of the kidneys, and, if not 
arrested, death ensues from blood-poisoning. 
In the acute form, the disease may not be so 
active as to produce death ; the inflammation 
gradually subsides, and merges into the 
chronic form, or the disease may be 
arrested, the inflammation entirely removed, 
the nervous energy re-established and the 
patient restored to health. 

2. The Chronic. — This form may result 
from the acute, or the disease may assume 
the chronic form from the start, and develop 
so gradually and imperceptibly as to be un- 
noticed by the patient, his friends or his 
physician. Most writers describe three 
stages of this form of B right's Disease based 
upon pathological changes observed after 
death : 

1 . That of inflammation with commencing 
exudation, frequently called tubal nephritis 
on account of the uriniferous tubes being 
the principal seat of diseased action. 

2. Granular Degeneration, in which exu- 
dation has taken place, which subsequently 
extends to the intertubular matrix. 



INFLAMMATORY STAGE. 89 

3. The Waxy or Lardaceous Form. — In 
this stage of the disease, the kidneys undergo 
degeneration and atrophy. 

These three forms or types of disease 
may be summed up as follows: 1. The 
smooth white kidney. 2. The granular 
mottled kidney. 3. The waxy or amyloid 
kidney. 

1. The Inflammatory or First Form 
of Chronic Bright's Disease.— The morbid 
changes are very similar to those observed 
in the acute form ; the inflammation is less 
active. If we examine the cortical sub- 
stance with a magnifying glass, we find scat- 
tered through it haemorrhagic spots, the 
result of congestion or engorgement of the 
glomerules, giving it a mottled or granular 
appearance. We also find an increase in 
the number and size of the oil-globules of 
the epithelium lining of the tubules. As 
the disease advances the tubes become dis- 
tended and filled with cast-off epithelium 
oil-globules and blood corpuscles, all mat- 
ted together, completely blocking a portion 
of the tubes, while others are comparatively 
free, their epithelium presenting a healthy 
appearance. In the ' more advanced stage 



90 BRIGHT'S DISEASE. 

of the disease the epithelium lining of the 
cortical portion of the tubes is destroyed, 
and fibrous casts of these tubes are thrown 
off The medullary portion and the glome- 
rules are not seriously involved. 

The hyperplastic process takes place in 
the basement membrane, and not in the 
epithelium cells as is generally supposed, 
and is dependent upon cnncrvation of nervo- 
vital energy, causing a rapid development of 
nerve cells and nuclei and an increase of oil- 
globules. Here growth over-reaches the 
boundary of harmony, by which it is guided 
in health. If this condition continues the 
epithelium is imperfectly formed, the walls 
of the tubes lined with the granular mass 
instead of cells. Fortunately for the patient 
this condition does not exist in all the 
tubules. If it did the excretory function of 
the kidney would be suspended and the 
nitrogenized products of waste retained in 
the blood, and the patient die of uraemia or 
blood poison. Occasionally in this stage of 
the disease, the structural change is not 
confined to the tubules, but extends to the 
fibrous structure in which fatty degenera- 
tion is found, causing an enlargement of the 



GRANULAR STAGE. 91 

organs to double their natural size, giving 
the kidneys a yellowish-white appearance — 
hence the name : the smooth white kidney. 

This form of Bright's Disease is generally 
traced to some exciting cause, as cold, con- 
sumption, pregnancy, scarlet fever, etc. In 
one hundred and six cases examined by 
Dickson, the average age was about twenty- 
eight years. 

The urine is scanty, pale and cloudy, 
specific gravity normal ; if permitted to 
stand, it deposits a sediment consisting of 
tube-casts, epithelial, fatty matter, granular 
and cretaceous substance. Dropsy is almost 
always attendant on this form ; the skin is 
white, flesh soft and flabby, face pale and 
puffy. There is seldom heart trouble ac- 
companying this type of the disease, but it 
is a frequent attendant in the granular form. 
There is very frequently, however, secondary 
inflammation as pneumonia, peritonitis, etc. 
It runs its course, however, in a much 
shorter time than the granular form, usually 
in from six to nine months. Occasionally, 
however, it may be prolonged for several 
years. 

2. The Granular or Second Form of 



92 BRIGHT'S DISEASE. 

Chronic Bright's Disease. — The kidneys 
are diminished in size and weight. The 
surface is very unlike that in the form just 
described, being uneven or rough, owing to 
the number of small elevations, varying in 
size from a pin's head to a pea. The capsule 
adheres closely to the adjacent surface, and 
presents a granular appearance. The texture 
of the kidney is tough and unyielding. If 
the cortical portion be examined, it will be 
found very much contracted, forming a thin 
rim around the pyramids, not more than 
one-sixth of an inch in thickness. If we 
examine it with a microscope, we find it has 
undergone a marked morbid change. The 
Malpighian corpuscles are diminished to 
half their size, and closely crowded together 
by a fibrous and granular investment. Por- 
tions of the tubes are denuded of their 
epithelium, and so contracted as to present 
mere tubular threads. Others are blocked 
up with broken-down epithelium and oil- 
granules. What is remarkable, normal or 
healthy tubes are found side by side with 
those that have become almost obliterated. 
It is the generally accepted opinion that the 
morbid process commences in the epithelium 



GRANULAR STAGE. 93 

cells lining the tubes. Dickson and Stewart 
maintain that it occurs in the inter-tubular 
space, which they consider an overgrowth 
or hypertrophy of the fibrous tissues which 
compresses the Malpighian corpuscles. In 
this way, they account for the contraction 
of the cortical portion of the kidney. As 
the disease progresses, the pyramids become 
involved, cysts are frequently met with, 
which vary in size from a pin's head to a 
pea. They are evidently formed by the 
obstruction and distention of the urinife- 
rous tubes, for they are found lined with 
an epithelium and filled with an exudation 
that is not urinous, but albuminous. These 
cysts are generally found in the cortical 
substance, and occasionally in the cones. 

This type of the disease makes its appear- 
ance insidiously, without any definite or ex- 
citing cause. It advances slowly, and may 
exist for months, and even years, and the 
sufferer be unconscious of it until it is dis- 
covered by his physician. The urine is 
generally at first copious and of low specific 
gravity. As the . disease advances the 
quantity gradually diminishes, the albumi- 
nous deposit is slight and occasionally ab- 



94 BRIGHT'S DISEASE. 

sent. In the majority of cases there are to 
be found in the urine epithelium and gran- 
ular casts, which are eliminated from the 
uriniferous tubes. In many, perhaps half 
of the cases, there is no dropsical effusion ; 
when it is present, it is generally limited to 
the ankles and under the eyes. Such per- 
sons are generally pale and anaemic, with 
countenance pinched, and the skin presents 
a sallow appearance. Hypertrophy, or en- 
largement of the heart, is a very frequent 
accompaniment, and from half to two-thirds 
of the cases are afflicted with this form of 
cardiac difficulty. There is a general 
cachectic condition of system, showing con- 
clusively an impaired nutrition. Out of two 
hundred and fifty cases examined by Dick- 
son, the average age was about fifty years. 

3. Third Form of Chronic Bright's 
Disease. — Waxy or Lardaceous Kid- 
ney. — In this form of the disease the kid- 
ney is usually enlarged. The cortical por- 
tion presents a whitish or light yellow color. 
If a section be examined with a microscope, 
it has a waxy appearance, and is confined 
almost exclusively to the muscular coats of 
the blood vessels. The Malpighian cor- 



THE THIRD STAGE. 95 

puscles are the first to become affected with 
this waxy deposit. As the disease advances, 
the arteries and capillaries of the entire kid- 
ney become involved ; the epithelium of the 
tubules is contracted and infiltrated with 
fat corpuscles ; the liver and spleen are 
usually found to contain the same fatty de- 
posit. The true nature and source of the 
waxy material has not been definitely de- 
termined. Dickson supposed it to be a 
species of fibrin, containing less alkali, and 
a larger proportion of earthy salts. Vir- 
chow believed that it belonged to the same 
class of substances as salt and cellulose, on 
account of its yielding a violet color when 
combined with sulphuric acid and iodine. 
It is evidently of a protean character, for it 
contains the same amount of nitrogen as 
the protean compounds. Lilje the granular 
form of this disease, it makes its appear- 
ance in cachectic persons, and comes on in- 
sidiously. In the commencement the urine 
is generally copious, and as it advances it 
diminishes in quantity, while its specific 
gravity increases. The albumen at first is 
but slight, but becomes quite profuse as the 
disease advances. The urine is pale, and 



96 BRIGHT'S DISEASE. 

contains epithelium cells and fat corpuscles. 
This form of the disease maybe diagnosed by 
the abundance of albumen in the urine, the 
profuse dropsical effusions, and the general 
wasting of the system. It is not unfre- 
quently complicated with syphilis or phthisis, 
and, when the system has been reduced, by 
constant suppuration. 



CHAPTER V. 

What is Bright's Disease? Its Cura- 
bility. 

Bright's Disease is generally understood 
to be an inflammation of the kidneys, either 
acute or chronic, and characterized by albu- 
minous deposits in the urine. We do not 
deny the correctness of this so far as 
the kidneys are concerned, but it declares 
only the effect of a cause which must be 
sought for, ascertained and controlled before 
we can expect to place it amongst the cura- 
ble diseases. Therefore to designate it as 
inflammation of the kidneys with albumi- 
nous deposits in the urine, does not give a 
correct idea of its character, magnitude or 
cause. 

The main object of this work is to call 
the attention of those suffering with this 
troublesome complaint to some new facts as 
to the cause, and afford them hope that, if 
the disease be treated in time, it will not be 
found incurable, as it is supposed to be by 
physicians generally. It is almost a univer- 
9 97 



98 BRIGHT'S DISEASE. 

sal opinion, in the profession, that the dis- 
ease, in its chronic form, is incurable, and 
they are often too free and decided in giving 
an unfavorable prognosis as soon as they 
ascertain that a person has Bright's Disease. 
This belief also prevails with the community, 
and when confirmed by the physician the 
patient gives up all hope of recovery, which 
naturally depresses fhe vital energies, and 
thus hastens the progress of the disease. 
On the contrary, we do not regard it as 
right and proper for the physician to buoy 
up the patient with false hopes. We have 
known instances in the last two years where 
persons afflicted with Bright's Disease could 
have been cured, or, if not cured, life pro- 
longed, where the attending physician 
insisted (when the patient contemplated 
change of treatment) that there was not the 
slightest hope for a cure. They asserting 
that the best authorities in the profession 
had pronounced the disease incurable — that 
settled it. Tvro of the cases to which we 
. have reference, are in their graves, while 
those who were quite as severely afflicted, 
if not more so, are enjoying comparatively 
good health. • 



THE VITAL FORCE. 99 

Disease being an abnormal life action, it 
will be necessary, in order to understand it 
properly, to have a knowledge of normal 
life, the former being merely a deviation 
from the latter. As life cannot be manifested 
without motion there must be, in the 
universe, a life energy. Many advanced 
scientific thinkers maintain that life results 
from molecular change. 

This cannot be correct, for the organized 
principle or vitalized energy controls the 
physical force. We find when there is an 
expenditure of nerve-force, disintegration of 
the tissues ensues, corresponding to the 
amount of vital energy manifested. If the 
brain be overactive or the nervous system 
overtaxed, or the function of an organ in- 
creased, we find an increase in the disinte- 
grated products eliminated from the system, 
which shows that more waste has taken 
place than when there is less activity. As 
no function in the physical economy can be 
performed without life existing, and, as life 
cannot exist without vital energy, the cause 
of disintegration, which is death, must be 
the relaxing of the vital or life force. The 
moment the vital force ceases its control 



100 BRIGHT'S DISEASE. 

over the molecular or physical force, disin- 
tegration ensues. To replace this waste 
with living structure, the vital energy again 
controls the physical forces ; if this did not 
take place, and disintegration continued, the 
system would soon be reduced to a condi- 
tion where life could not be sustained. In 
some parts of the organism, the waste is 
more rapid than in others ; this occurs 
where the vital energy is the most active. 
Waste and growth vary with age; from 
infancy to manhood or womanhood, the 
the growth exceeds the waste ; from the 
latter to the decline of life, they are nearly 
balanced. In old age, the waste exceeds 
the growth and at death growth ceases ; the 
vital energy is suspended and no longer 
controls the molecular or physical forces, 
and disintegration of the body follows as 
a natural result. In proof of the vital 
energy being the master-workman: when- 
ever it is overtaxed, we find the physical 
organism giving way, the waste being 
greater than the growth, the system soon 
becomes dilapidated and the vital force is 
gradually compelled to yield to the mole- 
cular, which, if continued, must terminate 



THE VITAL FORCE. 101 

in death. We have another proof of the 
control of the vital force over the physical 
in the unfecundated egg. If it be submitted 
to a normal temperature, it will decompose ; 
an egg fecundated, submitted to the same 
temperature, will develop into a chick. 
Many more facts could be given to verify 
our assertion, that the life-action taking 
place in the physical organism does not 
result from chemical or physical change, as 
Herbert Spencer and others would have us 
believe. His definition of life-action is : "A 
definite combination of heterogeneous 
changes, both simultaneous and successive 
in correspondence with external co-ex- 
istences and sequences." Or, as G. H. 
Lewis defines it, " A series of definite and 
successive changes, both of structure and 
composition, which takes place within an 
individual without destroying its identity." 
Neither attempts to define what it is that 
causes these changes and sustains the 
organism through physical life. 

The reader will naturally inquire what 

constitutes the vital force. We have already 

discussed what it is in Chapter II., when 

speaking of the function of the nervous sys- 

9* 



102 BRIGHT' S DISEASE. 

tern. It is the energy of the soul, which 
unfolds from the cell-germ with the physi- 
cal body, and is the force imparted by the 
parents. It is therefore purely a subjective 
force, and correlates with the organic nerve 
forces, the two combined constituting the 
nervo-vital forces. Growth is an integra- 
tion, a building up of organic structure, in 
which the vital and nerve forces are corre- 
lated. In disintegration, or decay, the cor- 
relation is suspended, and the physical 
forces are permitted to have control, re- 
ducing the tissues to their normal chemical 
condition. Death is nothing more nor less 
than a general disintegration. Nutrition is 
a nervo-vital action, in which the subjective 
or vital force, and the objective or nerve 
force, both participate, being correlated. 
When nutrition is impaired, as it is in 
Bright's Disease, the correlation of the two 
forces is disturbed. When a person is in vig- 
orous health, and has what is usually termed 
a robust constitution, the vital energy is 
active ; in impaired health and in old age it 
is inactive. We will therefore perceive that 
instead of life being the result of chemical 
or molecular changes, it is the reverse — it is 



A MALIGNANT GROWTH. 103 

death, not life. The scientists have placed 
the cart before the horse ; they have Nature 
turned up side down, or round about. 

If the nervous system undergoes the 
slightest structural change from impaired 
nutrition, or other causes, the correlation 
of the nerve and vital forces is impaired to 
the extent of the pathological change. 
Every intelligent physician knows that 
serious functional disturbance may take 
place in the nervous system, as in convul- 
sions, lock-jaw, etc., causing death, without 
leaving the slightest structural change be- 
hind. In such cases there is no derange- 
ment of the nervous structure ; it is merely 
an imperfect correlation of the forces. Such 
violent functional derangements may be 
compared to an organic cyclone or tempest, 
which is difficult to overcome, owing to the 
impossibility of re-establishing the correla- 
tion of the forces. 

About three years ago, the author con- 
cluded, after a strong appeal being made to 
save a life, to test his views of life-action in 
the treatment of a malignant growth. The 
unfortunate individual was a gentleman in 
his seventy-third year. He had a large 



104 BRIGHT'S DISEASE. 

fungus haematodes on his arm, just below 
the shoulder; an eminent surgeon was 
called in to examine the case with a view of 
removing it, or amputating the arm in order 
to get rid of the stench, if nothing more. 
He declined, stating that an operation could 
not be borne, and even if it could, it would 
not prolong life a great while, for his sys- 
tem was " rotton with cancer!' I undertook 
the case with no great expectation of bene- 
fiting him. In about three weeks after 
commencing treatment, a shrinkage was 
observed with the lessening of the dis- 
charge and odor. A few days after, the outer 
border of the tumor appeared to deaden and 
drop off, leaving a healthy surface. This con- 
tinued until the whole abnormal growth 
had disappeared, and the parts healed. The 
time occupied in the treatment was about 
four months. There were no local applica- 
tions used, the remedies were given with 
a view to improve nutrition, and to change 
the growth from an abnormol to a nor- 
mal one. It is over two years since this case 
was treated and there has been no return. 
A similar plan of treatment must be adopted 
in Bright's Disease, in which there are two 



ESSENTIALS. 105 

conditions that must be met : one is the 
congestion of the kidneys and the other a 
structural change taking place in the cortical 
portion of the same. In the former, the 
capillaries surrounding the uriniferous 
tubes are relaxed, owing to an ennervation 
of the vaso-motor energy permitting too 
much blood to be eliminated from the capil- 
laries for the formation of a normal base- 
ment membrane, causing an increased cell 
development, and a corresponding disinte- 
gration. It is well known among physiolo- 
gists that the activity of epithelium cells 
depends upon the amount of blood supplied 
and the nervo-vital energy imparted to it. 
If the capillaries of the salivary glands be 
dilated, the increased flow of blood to the 
glands causes a rapid increase in the secre- 
tions, and a more rapid disintegration of 
the cells ; on the contrary, if the blood-sup- 
ply be diminished, the secretions are 
lessened and become more fluid or watery. 
If the nerves leading to these glands be 
divided, the secretions become vitiated or are 
entirely suspended, proving that nervo-vital 
energy and blood-supply, are the essentials 
for cell-action. The same will apply to all 



106 BRIGHT'S DISEASE. 

secretory or excretory cell structures. If 
the secretions are increased, there must be 
a corresponding increase of cell formation, 
and a corresponding cell disintegration. 




Fig. 9. 
Morbid products observed in the urine in Bright's Disease : a, 
epithelium casts ; b, 5, transparent or hyaline casts ; c, d, fatty- 
matter. (From Reynolds.) 

This condition we find in the kidneys in 
Bright's Disease. In its early stage, there 
is a congestion of the kidneys from a 
relaxation of the capillaries, permitting an 
increased elimination of blood serum to the 



GROWTH AND DISINTEGRATION. 107 

basement membrane, an increase of epi- 
thelium cell formation, and an increased 
secretion, providing the nervo-vital energy 
is not too greatly ennervated. As activity 




Fig. io. 

Morbid products eliminated by the kidneys in Bright's Disease, 
and observed i 1 the urine by the aid of the microscope. a y a, fatty 
casts ; b, b granular casts ; d, d, free fatty molecules. (From 
Reynolds). 

of growth must be attended by a corres- 
ponding disintegration, we find a large 
amount of epithelium cells in the urine. 
As the nervo-vital energy becomes more 
exhausted, we find the cell-lining of the 



108 



BRIGHT'S DISEASE. 



tubes thrown off before they have accom- 
plished their office, which is the elimination 
of the solid contents of the urine. These 
are called epithelium tube-casts [Figs. 9, 




Fig. 11. 

a, a, transparent casts observed in the urine in a case of chronic 
Bright's Disease of eight months' duration; b, &, the same form of 
casts from chronic Bright's Disease (large white kidney) ; c, the 
same form of casts from a case of chronic Bright's Disease (con- 
tracted kidney, with fatty degeneration). (After Reynolds.) 

10 and 11]. As the exhaustion continues, 
the cells are not formed, there not being 
sufficient vital energy imparted to the 
substance of the basement membrane to 



TUBE-CASTS. 109 

develop the growth of cells beyond the 
granular layer [Fig. 5]. 

If a still greater exhaustion of nervo-vital 
energy occurs, we find but slight traces of 
vital action in the basement membrane; no 
more than is sufficient to organize the 
membrane into a semi-gelatinous condition, 
as we find in the amoeba, or lowest organ- 
isms. In this stage of the disease we find 
in some of the tubes no trace of the granu- 
lar or epithelium layers, nothing more than 
a structureless membrane, which is thrown 
off and called transparent tube-casts [Fig. 
11]. The formation and elimination of 
the three forms of tube-casts have never 
been explained. The views we have ad- 
vanced of vital energy and life action in- 
dicate the progress of Bright's Disease as 
it is manifested in the kidneys. With the 
aid of the microscope'we may, by observing 
these different tube-casts in the urine, ascer- 
tain the progress of the disease by the too 
rapid disintegration, which is not checked 
because the vital energy has become weak- 
ened. While these changes in the cor- 
tical substances are going on, the medullary 



10 



110 BRIGHT'S DISEASE. 

portion of the kidneys becomes involved, 
owing to the same ennervation. 

In order to impress upon the mind of the 
reader, we assert that no life action can take 
place in the material organism without the 
correlation of the soul or vital force and 
molecular nerve force, the action of the two 
constituting physical life. Simple hyper- 
trophy is a derangement of the correlation 
of the nervo-vital energy, with an increase 
of the vital over the molecular energy, 
inducing change of form, but not of type. 
Simple atrophy is a derangement of the cor- 
relation of the same energies, with a decrease 
of the vital, also causing change of form, but 
not of type. When the change of type and 
form both occur we have abnormal growth, 
the malignancy of which will depend upon 
the extent of the impaired correlation. In 
the most malignant form of cancer, such as 
the fungus haematodes, the correlation of the 
forces is almost suspended, and the vitality 
of the part is at a very low ebb. The same 
law will apply to all structural changes, or 
functional derangements occurring in the 
living organism. 

It would afford us pleasure to dwell 



DISAPPROBATION. Ill 

more fully on this important and interesting 
subject of vital energy, but space will not 
permit, and we shall therefore refer the 
reader, if interested in the subject of life, 
and how it may be prolonged, to a subse- 
quent work we hope soon to have ready 
for the press. 

Before closing the chapter we wish briefly 
to express our disapprobation of the stress 
laid on pathological changes observed after 
death, as a chief guide to diagnosis of dis- 
eased action. It is remarkable with what 
care physicians, in examining bodies after 
death, note the color, form, consistency, 
etc., of the diseased parts, without searching 
for the cause of their abnormal changes. 
The heart may be as large as that of an ox, 
or as small as that of a dog ; the brain 
as hard as a Dutch cheese, or as soft as 
lard ; the liver as white as the face of a 
Caucasian, or as dark as the face of a Ma- 
lay; the kidneys may be enormously en- 
larged, or shrunken to half their natural 
size. Yet what does all this prove ? Simply 
a change of structure from a cause unper- 
ceived by the pathologists. Mr. Lee quotes 
in his " Mineral Springs of England," the 



112 BRIGHT'S DISEASE. 

following from the pen of Dr. Kreysig, 
which is pertinent to the question we are 
now discussing. He says : " Physicians 
are in the habit of regarding the solid parts 
as the primary agents of life, to which the 
fluids are subordinate; but, on the con- 
trary, the blood and the nervous system are 
the primitive and essential instruments of all 
the organic functions, while the solid parts 
occupy the inferior grades, and are of but 
secondary importance in disease. The ele- 
ments of general and internal disease, or 
the morbid predispositions which form the 
most important objects of treatment, may, 
then, all be reduced to a vitiated state of the 
blood and the lymph, or to *the derange- 
ment of the nervous system/' We would 
remark that the " blood" and the " lymph" 
could not become vitiated excepting through 
ennervation of energy of the organic nerv- 
ous system. Professor George B. Wood* 
taking exception to the generally received 
opinion as to the cause of albuminuria, states : 
" The most probable explanation appears to 
be that there is some failure in the vigor 
of the assimilating process, dependent on 

♦Treatise on the Practice of Medicine, Sec. Ed., Vol. II, p. 508. 



SEMMOLA'S VIEWS. 113 

the same cause which has predisposed the 
[kidneys, to the morbid deposition going on 
within them, and that the two effects, in- 
stead of having any mutual dependence, are 
merely co-existing results of the same con- 
cealed agency." Dr. Henry Hartshorn, in 
the American edition of Reynold's System 
of Medicine, Vol. Ill, page 662,* states that 
" Semmola insists that true Bright's Dis- 
ease is always connected with; or consists 
in a general nutritive disorder, to which the 
affection of the kidneys is secondary. This 
disorder begins, according to his statement, 
in an arrest of cutaneous respiration. Next 
follows imperfect digestion, and transforma- 
tion of albuminoid food ; and the presence 
of an excess of albumen, with deficient 
formation of urea in the blood. Hence re- 
sults renal irritation and inflammation, albu- 
minuria, and diminished excretion of urea. 
At a later period, when the kidneys have 
undergone considerable morbid alteration, 
the secreting structure fails to eliminate the 
urea which is formed. Then, and not be- 
fore, will uraemia take place. Semmola con- 



* Gazette Medicate de Paris, 1875, quoted in British Medical 
Journal, September 27th, 1879. 

IO* 



114 BRIGHT'S DISEASE. 

siders that pathologists have generally too 
much neglected the dyscrasic character of 
Bright's Disease, and its special dependence 
(being thus set apart by him from albumi- 
nuria, or other causes, e.g. alcoholism, gout, 
etc.), upon the gradual action of cold upon 
the skin." The source of Bright's Disease, 
from observation and treatment, is not to be 
found in the pathological changes observed 
in the kidneys after death. They are merely 
the effect of a cause that must be sought 
for and ascertained before it can be success- 
fully treated. The disease may exist for 
a long time before any morbid change is ob- 
served in the functions and structure of the 
kidneys. Of this we shall speak more fully 
in the chapter on the cause of Bright's 
Disease. 

As this work is not written for the pro- 
fession, but for those predisposed to and suf- 
fering from Bright's Disease, we have not 
considered it advisable to give treatment, 
as any educated physician, who understands 
the functions of the organic nervous system, 
will be able to select suitable remedies to 
correct ennervation, overcome renal conges- 
tion, and improve nutrition. This is all 



HEALTH RE-ESTABLISHED. 115 

that is required of the physician. Nature 
will accomplish the rest, providing too 
serious structural changes have not oc- 
curred in the kidneys, and too serious com- 
plications have not taken place in other or- 
gans. Physicians familiar with Bright's 
Disease must have observed that in many 
cases of the chronic form, before the disease 
has become established, serious local troubles 
have occurred in other parts of the system, 
This proves that the ennervation is not con- 
fined to the kidneys, but is very generally 
diffused, and by correcting it nutrition is 
re-established, structural changes gradually 
disappear, abnormal functions are restored 
to their natural condition, and health is 
re-established. The nervo-vital energy has 
great recuperative powers, and all that is re- 
quired is assistance from a skilful and edu- 
cated physician. 



y 



CHAPTER VI. 

Symptoms of Bright's Disease. 

We have already stated that Bright's 
Disease is usually divided into acute and 
chronic, and the latter is again divided into 
three or more forms, corresponding to the 
pathological changes observed. 

i. The Acute Form. — This form of. the 
disease makes its appearance suddenly, and 
generally attended with chilliness, fever, 
headache, nausea and vomiting. There is 
frequently a dull, aching-pain in the region 
of the kidneys, with soreness on pressure, 
and skin dry. Dropsy usually appears very 
early and generally commences in the face, 
causing a fullness under the eyes, with a 
stupid or heavy expression of countenance. 
It soon extends to the upper extremities, 
making its first appearance in the hands. 
Soon the chest becomes involved, and, 
finally, the lower extremities. In males, the 
scrotum is a favorable location for the 
dropsy to make its appearance ; sometimes 
it becomes almost as large as a child's head. 

116 



GENERAL SYMPTOMS 117 

In a few cases, the swelling commences in 
the feet and extends upwards, becoming 
general. If the patient should be kept in a 
recumbent position, the back is the part 
most swollen ; as the dropsical effusion in- 
creases, there is a corresponding lessening 
of the quantity of urine secreted. In some 
aggravated cases, it is completely sup- 
pressed, which is a very alarming symptom. 
In the early stage of the disease, the urine, 
instead of having the natural amber color, 
presents a smoky appearance, which is 
owing to the coloring matter of the blood. 
The urine has an acid reaction, and a spe- 
cific gravity ranging from 1025 to 1030, 
and has been known to reach as high as 
1060. If the disease passes into the 
chronic form, the specific gravity lessens 
and may fall as low as 10 10. If the urine 
be permitted to stand for a short time, a 
flocculent, brownish sediment forms. If 
it be examined with a microscope, it will be 
found to consist of blood corpuscles, epi- 
thelial cells, free nuclei, coagulated fibrin 
and tube-casts, which consist of three forms 
corresponding to the three layers of the 
walls of the uriniferous tubes. They are 



y 



118 BRIGHT'S DISEASE. . 

described as the epithelial, the granular and 
the hyaline or transparent tube-casts [see 
Figs. 9, 10 and n]. The first, called the 
epithelium, constitutes the secreting portion 
of the tubes ; the second, the granular, lies 
immediately below the former, and the third 
is the hyaline or transparent, formed of 
lymph eliminated from the capillaries, of a 
semi-fluid character, and forming what is 
called the basement membrane of the tubes. 
When these layers are all thrown off, the 
tubes are obliterated or completely des- 
troyed, leaving the capillary network, which 
is highly congested. Fortunately, it is 
only a part of the uriniferous tubes that is 
destroyed (excepting in extreme cases), 
the others being comparatively healthy, or 
merely stripped of a portion of their epi- 
thelium. There are also found in the sedi- 
ment oil-globules, which are a normal 
product of the kidneys, found distributed 
among the tubules. 

If the urine be boiled it will be found to 
contain a large amount of albumen which is 
the characteristic feature of Bright's Dis- 
ease. The normal constituents of the urine 
such as urea, uric acid, etc., are very much 



FAVORABLE SYMPTOMS. 119 

reduced in quantity, owing to the structural 
change taking place in the uriniferous tubes, 
they being the natural channel through 
which they are eliminated. The drain of 
albumen from the blood impoverishes it and 
the retention of the nitrogenous products 
poisons it. The two combined depress the 
vital energies of the system, causing an 
imperfect assimilation which is shown in 
the diminution of blood corpuscles. The 
reduction of the red corpuscles of the blood 
and the anaemia caused by it, are attributed 
to the amount of blood eliminated by the 
kidneys. This is so small that it will not 
account for it; another cause must be 
sought for. We attribute it to imperfect 
assimilation caused by an ennervation of the 
organic nervous system. 

The acute form of the disease may con- 
tinue for a few days or many months, and 
the patient apparently recover, or it may pass 
into the chronic form and continue for many 
years. If it should have a favorable termi- 
nation, the quantity of urine will be in- 
creased, the specific gravity diminished, the 
albumen will gradually subside and the 
tube-casts disappear in the urine. The skin 



120 BRIGHT'S DISEASE. 

becomes moist and the dropsical effusion ab- 
sorbed. Convalescence is generally slow, 
and requires from two to six months for the 
kidneys to assume their natural functions 
and the system to recover from the shock. 
Recovery is not complete until the urine is 
entirely free from albumen, and the dropsical 
symptoms have entirely disappeared. If 
albumen continues in the urine w T ith tube- 
casts, it is evidence of structural change go- 
ing on in the cortical substance and of the 
disease assuming a chronic form. Some- 
times in the acute form the albumen almost 
disappears from the urine, which may be 
merely a lull in the disease to be followed 
by an exacerbation more severe than the 
previous attack, A relapse of this kind may 
generally be attributed to cold and damp- 
ness, diseased kidneys being very suscepti- 
ble to both. 

The unfavorable symptoms of the acute 
form are an increase of the albumen, a dimi- 
nution of the quantity of urine passed and 
a change in the color of the urine, which 
becomes darker, owing to the elimination of 
blood. 

This form of Bright's Disease is occa- 



COMPLICATIONS. 121 

"sionally accompanied with complications 
which are considered by some writers as 
local symptoms. For example, oedema of 
the lungs they regard as a general dropsy. 
Inflammation of the serous membrane very 
frequently takes place. Pleurisy is the most 
common ; pericorditis is less frequent, and 
peritonitis very seldom occurs. Pneumo- 
nia is- occasionally a complication but not 
so frequent as bronchitis. Hypertrophy 
of the heart rarely occurs in the acute, but 
is a frequent complication in the chronic, 
form of the disease. 

cute Bright's Disease is not confined to 
any particular age ; a large majority of cases 
occur during childhood and youth, and as a 
general rule the person attacked has previ- 
ously enjoyed good health. 

II. Chronic Form. — The general symp- 
toms of Chronic Bright's Disease cannot be 
more clearly given than in the following'ex- 
extract from Reynolds' " System of Medi- 
cine," American Edition by Dr. Hartshorn : 

" In the gre^t majority of instances 

chronic Bright's Disease begins slowly and 

imperceptibly. The attention of the patient 

is awakened, some months, or it may be 

ii 



122 BRIGHT'S DISEASE. 

years, after it has existed, by the gradual 
failure of his strength and his increasing 
pallor or sallowuess, with a disinclination to 
exertion ; or his suspicions are aroused by a 
little puffiness under the eyes, a slight swell- 
ing of the ankles at night, unusually fre- 
quent calls to void urine, or shortness of 
breath. In other cases these premonitions 
pass unheeded or are altogether wanting. 
The disease proceeds silently, amid appar- 
ent health, and then suddenly declares itself 
by a fit of convulsions, rapid coma, amau- 
rosis, pulmonary oedema, or a violent inflam- 
mation ; or it may lie concealed for an un- 
determined period, and then reveal itself, 
after exposure to cold or a fit of intoxica- 
tion in the guise of an acute attack, with 
rapid general anasarca, scanty, sanguineous 
urine ; or it may be a continuation or se- 
quela of acute Bright's Disease ; or lastly, it 
may creep on stealthily in the wake of some 
pre-existing chronic disorder, phthisis, caries, 
necrosis, constitutional syphilis, gout, chronic 
alcoholism, or exhausting suppuration. 

" The principal symptoms of the disease 
are : albuminous urine with deposits of tube- 
casts and renal epithelium, especially at 



GENERAL SYMPTOMS. 123 

night; dropsical effusions into the subcuta- 
neous cellular tissue, serous cavities, or pul- 
monary substance; dryness of the skin, de- 
rangements of digestion ; progressive hy- 
dremia ; uraemic phenomena (headache, am- 
blyopia, convulsions, coma, vomiting, and 
diarrhoea) ; hypertrophy of the left ventricle ; 
secondary inflammation of the parenchyma- 
tous organs and serous membranes. 

" Few cases present the whole of these 
symptoms : many present only two or three 
of them. The alterations in the composi- 
tion of the urine are the most invariable, 
and also the earliest and most distinct symp- 
toms ; next follow in the order of constancy, 
the deterioration of the blood, the dropsical 
symptoms, and, lastly, the uraemic and in- 
flammatory incidents. 

" The disease usually pursues an inter- 
rupted course, being subject to occasional 
exacerbations, with intervals of quiescence. 
The exacerbations are generally by expo- 
sure to cold, or some imprudence in diet 
or regimen ; sometimes no cause can be as- 
signed for their occurrence. They are 
marked by pyrexia, and often simulate an 
attack of acute Bright's Disease. The inter- 



124 BRIGHT'S DISEASE. 

vals of quiescence may be some weeks or 
months, or a few years ; the remission of 
the symptoms is commonly only partial, 
the main features of the disease persisting, 
though in a modified degree. Sometimes, 
however, the remission is almost complete, 
and little except the albuminous state of the 
urine remains to attest the existence of 
renal mischief; and even this may, in ex- 
ceptional cases, be absent, and the nature 
of the case be first revealed at the autopsy. 
After each exacerbation it is commonly 
pretty evident that the disease has pro- 
gressed a step, and probably an additional 
portion of the kidney, hitherto spared or 
only slightly affected, has been disabled. 
The kidneys are at length so seriously dis- 
organized, and their depurative functions so 
far abrogated, that life becomes impossible. 
" The immediate cause of death is vari- 
able. Sometimes the sufferer passes quietly 
away, exhausted by anaemic, burdensome 
anasarca, and defective digestion. About 
one-third of the subjects of chronic Bright's 
Disease perish by uraemic poisoning, either 
in the form of coma and convulsions or 
irrepressible diarrhoea and vomiting. A 



SPECIAL SYMPTOMS. 125 

considerable number die from the intensity 
or dangerous situation of the dropsical 
effusion, as when the glottis or lungs are 
invaded ; or death results from the hydro- 
thorax, or from gangrenous erysipelas set 
up in the tense oedematous integuments of 
the legs, thighs, or genitals. About one-fifth 
die by secondary pneumonia, pericarditis, 
or double pleurisy. The remainder are cut 
off by remote complications, as apoplexy, 
cirrhosis, phthisis, intestinal ulcerations, etc. 

" The duration of the disease can only be 
approximately ascertained from the difficulty 
of assigning the exact date of invasion. 
Enough is, however, known to show that it 
varies within very wide limits. The usual 
period is from two to three years ; but cases 
may end in six months, or be protracted for 
four or five years. Exceptional instances 
have been recorded in which patients have 
survived ten years, and even fifteen and 
twenty years." 

Special Symptoms and Complications: 
Urine, — "The quantity of albumen is 
variable. The urine may become absolutely 
solid on boiling, or it may contain only the 
minutest traces of albumen, even in con- 
ii* 



126 BRIGHT' S DISEASE. 

firmed and fatally-tending cases. The 
amount of albumen lost in twenty-four 
hours varies commonly from forty-five to 
three hundred grains ; Dr. Parks observed 
in one instance, five hundred and forty-five 
grains. During digestion, the quantity is 
larger (it may be double) than during fast- 
ing; it rises and falis irregularly in the 
course of the disease, sometimes diminish- 
ing to a trace, and anon increasing to an 
intense impregnation. 

" The urine is generally pale and slightly 
turbid, depositing, on standing, amorphous 
whitish sediment of renal epithelium and 
tube-casts. It sometimes contains blood, 
occasionally in quantity, but generally in 

microscopic proportions When 

the case is complicated with phthisis, or 
regurgitant heart disease, the urine may be 
high-colored and turbid from lithates. 

"The quantity of urine voided per day 
varies with the type of the disease, and the 
presence or absence of pyrexia, sweating, 
vomiting, or diarrhoea. The specific grav- 
ity is low when the urine is copious (1006 
to 1010); but when scanty, the specific 
gravity may rise to 1030, or even to 1040. 



SPECIAL SYMPTOMS. 127 

The urine is nearly always acid, and not 
unfrequently deposits uric acid and oxalate 
of lime. Occasionally I have noted alka- 
line from a fixed alkali, and on two occasions 
ammoniacal on emission. The renal deriva- 
tives are markedly scantier in chronic than 
in acute Bright's Disease; they are not un- 
usually entirely absent for limited periods. 
They are, however, sometimes discoverable 
when the urine has temporarily ceased to 
be albuminous. The epithelium cells may 
be simply withered ; more rarely they are 
totally disintegrated into an amorphous 
granular debris; in other cases they contain 
specks of oil, or they may even be wholly 
converted into an agglomeration of oily 
particles, so as to appear identical with the 
granular corpuscle, or inflammation globule. 
If the casts are similarly speckled with fat, 
and free oily dots are scattered over the 
field, it indicates a fatal disorganization of 
the organs — either large, fatty kidneys, or 
contracted granular ones. Considerable 
diversity in the character of the casts, dis- 
charged by the same individual, even during 
the same day, may be met with, arising 
from a different condition of the several 



128 BRIGHT'S DISEASE. 

parts of the gland; conclusions as to the 
probable state of the kidney can only be 
drawn from the. prevailing character of the 
deposit, and not from one or two individual 
casts or cells. The casts most commonly 
seen in chronic B right's Disease are ' small ' 
and ' large* hyaline forms and 'granular* 
opaque ones, any of which may have a few 
wasted epithelium cells strewed over them. 
Perfect 'epithelial' casts are rare; blood- 
casts are also rare, in chronic cases, unless 
there be concomitant tricuspid regurgitation. 
Large hyaline casts result from exudation 
having been thrown into tubuli denuded of 
their epithelium. [The more rational con- 
clusion is that the hyaline cast is the base- 
ment membrane that has not advanced to 
the granular state, and that the granular 
cast is the basement membrane that has not 
advanced to the epithelium state. S. P.] 
The longer the exudation is retained within 
the tubuli, the darker and more granular 
the casts, and vice versa) casts speedily dis- 
charged are commonly hyaline. Some- 
times casts are darkened by the coloring 
matter of the blood, and the opaque granu- 
lar ones are sometimes composed of crushed 



CHANGES IN THE BLOOD. 129 

epithelial debris, moulded in the form of 
tubuli. [Are not the opaque granular casts 
the granular base with imperfectly formed 
epithelial cells? S. P.] 

"The normal solids of the urine are all 
diminished in chronic Bright's Disease. 
The urea is, as a rule, markedly reduced, 
the daily quantity averaging only about one 
hundred grains ; Frerichs has observed it as 
low as fifteen grains. A case is mentioned 
by Mosler, however, in which six hundred 
and forty grains were voided in one day! 
There is no correspondence, direct or in- 
verse, between the urea-excretion and the 
discharge of albumen." 

Blood. — " The changes in the blood are 
the complement of those in the urine; it 
becomes more watery and poorer in albu- 
men and red corpuscles, while the urea, uric 
acid, extractive matter, and pale corpuscles 
are relatively increased. This alteration 
in the composition of the blood is deeply 
concerned in the production of the more 
prominent features of the disease — the an- 
aemia, dropsical effusions, uraemic phe- 
nomena, and secondary inflammations. 

" Dropsy is much oftener absent in the 



130 BRIGHT'S DISEASE. 

chronic than in the acute form. It is much 
more constant with the smooth large than 
with the granular contracted kidney, of 
which probably one-third or one-fourth of 
the cases run their entire course without 
dropsy. The effusion begins quite as often 
in the feet and legs as in the face, and is 
apt to change its seat capriciously; some- 
times it is excessive and general, but usu- 
ally slight and partial. When the heart 
or liver is diseased, ascites and oedema of 
the legs become unduly prominent. The 
effusion may disappear totally for months, 
and then return ; more frequently after the 
subsidence of the general dropsy, oedema 
lingers obstinately in one or more places, 
over the flat of the tibiae, about the ankles, 
beneath the eyelids, or about the genitals. 
The presence or absence of dropsy gen- 
erally, but by no means always, corresponds 
with the abundance or scantiness of the 
urine, but it has no relation to the amount 
of albumen. 

" The skin is usually obstinately dry ; 
perspiration is quite exceptional. . . . 
. > Profuse sweating does, however, some- 
times takes place spontaneously, and may 



COMPLICATIONS. 131 

even continue for weeks. . ... The 
integuments in some cases are excessively- 
pale and glossy, more commonly sallow and 
rough. There is little or no tenderness in 
the renal region in the chronic cases, and 
the frequency of micturation is mostly- 
observed at night. Some degree of bron- 
chitis is almost an invariable coincident in 
both acute and chronic Bright's Disease. 

" Complication and Connection with 
Other Diseases. — The digestive organs 
are nearly always disturbed ; at first, there 
is anorexia [loss of appetite] and nausea, 
and, later, frequent or even uncontrollable 
diarrhoea and vomiting are not unusual. . 
. . Secondary inflammation of the lungs, 
endocardium, pericardium, peritoneum, or 
integuments, may break out at any period 
in the course of Bright's Disease, and the 
tendency to these constitutes one of the 
principal dangers of the complaint. 

" Bright's Disease and Phthisis. — This 
complication is of frequent occurrence. In 
the great majority of cases the pulmonary- 
disease is far advanced before renal symp- 
toms appear, the long-continued discharge 
of pus from the lungs at length giving rise 



132 BRIGHT'S DISEASE. 

to waxy changes in the kidneys, followed 
by albuminuria and dropsical effusions. 
But sometimes the renal disease precedes 
the pulmonary, and the changes found in 
the kidneys after death are not invariably 
of the waxy type." 

Hypertrophy of the heart, especially of 
the left ventricle, is a very frequent attend- 
ant in chronic Bright's Disease, which is 
supposed by Traube to be caused by in- 
creased tension in the arterial system, pro- 
ducing an increased resistance, which the 
left ventricle has to overcome. 

Uraemia. — The prominent symptoms are 
drowsiness, impaired vision, and dullness of 
hearing, nausea, vomiting, diarrhoea, and 
finally coma or convulsions. The cause 
is the retention in the blood of disintegrated 
products, owing to a derangement of the 
functions of the kidneys. The headache is 
generally in the forehead, vertex, and back 
of the head, and deep in the orbits. There 
is also a sense of weight and compression, 
attended with dimness of vision, which 
comes and goes, or may be attended with 
temporary loss of sight. The coma comes 
on insidiously, and may not be noticed by 



COMPRESSIBLE PULSE. 133 

those in attendance, supposing it to be 
nothing more than drowsiness, until convul- 
sions occur. Not unfrequently the coma 
and convulsions occur simultaneously. As 
a rule the urine is very greatly diminished, 
or completely suspended before the coma 
and convulsions take place. These may be 
regarded as alarming symptoms, and if not 
relieved promptly, will terminate fatally 
within a short time. 

It will not be amiss to mention an obscure 
symptom of Bright's Disease, which, if not 
interesting to the general reader, may be of 
service to physicians, if they have not already 
observed it. It is a feebleness of the heart, 
causing a weak and compressible pulse, 
which becomes more so as the disease ad- 
vances. The heart's energy is derived from 
the medulla oblongata, through the pneumo- 
gastric nerve. The medulla is the co- 
ordinating centre of the spinal system, and 
the solar ganglion the co-ordinating centre 
of the organic or sympathetic nervous sys- 
tem. The pneumo-gastric nerve distributes 
the energy that controls respiration, and the 
action of the heart and its branches anas- 
tomose with the solar plexus. It is from 
12 



134 BRIGHT'S DISEASE. 

this plexus that the uriniferous tubes (the 
seat of Bright's Disease in the kidneys) re- 
ceive their nerves. It is well known among 
physiologists that an injury to the medulla, 
or to the pneumo-gastric, brings about albu- 
minous deposits in the kidneys, as well as 
diabetes. This shows the intimate relation 
existing between the two great co-ordinating 
centres, the medulla oblongata, situated at 
the upper portion of the spinal cord, and the 
semi-lunar ganglion, the centre of the or- 
ganic nervous system. 

I would also remark that one of the first 
evidences of improvement in Bright's Dis- 
ease is in the action of the heart giving 
more tone to the pulse, thus enabling it to 
offer more resistance to pressure. The en- 
feebled condition of the pulse is not con- 
fined to Bright's Disease, but is frequently 
found in various forms of chronic diseases. 
In all cases exhibiting this form of pulse, 
with symptoms favoring Bright's Disease, I 
have invariably examined the urine, and very 
frequently found traces of the disease. It 
therefore gives us a cue in many cases 
which might otherwise be overlooked until 
the disease becomes permanently established. 



CHAPTER VII. 

Causes of Bright's Disease. 

/The causes of disease may be classified 
as primary and secondary, the latter recog- 
nized as the exciting cause. The primary 
is an ennervation of the organic nervous 
system, the secondary is the one that brings 
out, or makes manifest, the primary cause. 
As Bright's Disease assumes two distinct 
forms, acute and chronic, and the exciting 
causes being different in the former from 
what they are in the latter, we will, in order 
to make the subject clear, speak of them 
separately. 

i. Secondary, or Exciting Causes of 
the Acute Form. — A large percentage of 
the acute cases of Bright's Disease are 
sequelae of scarlet fever, and other infectious 
diseases, such as diphtheria, small-pox and 
measles ; skin diseases and extensive burns 
are also recognized as secondary causes. 
Some of the mineral and vegetable poisons 
are known to have been the means of de- 
veloping Bright's Disease by causing 

135 



136 BRIGHT'S DISEASE. 

inflammation of the kidneys. Among the 
mineral poisons are arsenic, lead, nitrate of 
silver, and mercury, and among the vege- 
table, turpentine, phosphorus, oils of worm- 
wood and mustard. Cantharides, which we 
find in some medical works classified with 
the vegetable poisons, is not a vegetable, 
but an animal product ; it is a very active, 
exciting cause, inflaming the kidneys, 
and, in fact, the whole urinary tract. Alco- 
holism is a very frequent cause of both the 
acute and chronic forms. What is called 
"moderate drinking" is potentially an excit- 
ing cause not only of Bright's Disease, but of 
gout, heart troubles and liver complaint. Phy- 
sicians are almost universally of the opin- 
ion that the drinking of alcohol in any form, 
save at meals, should not be indulged in. 
Pregnancy is also a cause, and generally 
occurs in lymphatic persons of a weak or 
feeble constitution with soft and flabby 
muscular fibre. Protracted and low forms 
of fever are occasionally a cause of the 
acute form of this disease. 

2. Secondary or Exciting Causes of 
the Chronic Form. — The causes of this 
form of Bright's Disease are more nupier- 



SECONDARY CAUSES. 137 

ous and more insidious in their action than 
those of the acute. Perhaps the most fre- 
quent causes are fast living, mental strain, 
anxiety and moderate drinking. Over- 
indulgence in eating or drinking impairs the 
functions of the digestive organs, particu- 
larly the stomach and liver. The kidneys 
are overtaxed in the elimination of the 
superabundance of nitrogenous products of 
the food not required for the growth of 
tissue, and which must be eliminated. The 
liver being overtaxed from the excessive 
carbon and hydrogen of the alcoholic 
drinks, becomes weakened in its functions, 
and the kidneys are called upon to elimi- 
nate not only the superabundance of food, 
but also the carbon and hydrogen that the 
liver cannot. In this way the kidneys 
become involved. 

We can thus account for the frequency of 
the disease in apparently strong and vigo- 
rous constitutions, in persons of fine phy- 
sique. Among statesmen and the mercan- 
tile community the active cause is mental 
strain, sleeplessness, and want of proper 
rest — in many cases accompanied with 
anxiety. During the war it became more 
12* 



138 BRIGHT'S DISEASE. 

frequent and after the collapse of business 
in 1875 it increased. Alcoholism without 
anxiety or mental strain is sufficient to 
cause Bright's Disease ; a confirmed tippler 
whose system is saturated with alcohol is 
very apt to have fatty degeneration of the 
liver and kidneys. Frequent exposure to 
cold and dampness by checking perspiration 
often causes congestion of the kidneys and 
leads to a morbid condition which is subse- 
quently increased by chilling of the body. 
Sexual excesses, consumption, syphilis, 
deep-seated abscesses, long-continued sup- 
purating surfaces, are also active causes. 
Malaria of late years is assigned as a cause 
by depressing the vital energy of the or- 
ganic nervous system. Heredity is another 
cause, which in one or more subsequent 
generations, owing to the present frequency 
of the disease, will very likely show itself 
actively. The weakness of parents is im- 
parted to their offspring, and will crop out 
at some period of life ; if not in their 
children, it will in their grandchildren. 
It is not an unfrequent occurrence 
for a hereditary disease to skip a genera- 
tion ; when it does, it generally reappears 



COMPARATIVE AGES. 139 

in an aggravated form. Simon found that 
confining animals in a dark room for a long 
time produced a fatty degeneration of the 
kidneys. Was it the absence of light, or 
the fear and despondency induced by the 
confinement ? Light is evidently a vital 
tonic, but it is questionable whether the 
simple confinement in darkness would be 
sufficient to produce structural change in 
the kidneys. 

Chronic Bright's Disease more frequently 
occurs between the ages of 30 and 60 years, 
seldom in children. Dr. Dickinson ob- 
served the disease in a lad of five years and 
Dr. Gee in the case of a boy of two and a 
half years. 

The following table of 61 cases of the 
lardaceous form has been compiled by Dr. 
Dickinson: 

Age,o-io, No. of Cases, 3 

11-20, 11 

21-30, 21 

31-40, 10 

41-50, 10 

51-60, 3 

61-70, 3 

Over 70, o 



140 BRIGHT'S DISEASE. 

Dr. Dickinson also gives a table of 308 
cases of the granular kidney, 

1 was between 11 and 20 

24 were 21 and 30 

50 31 and 40 

93 41 and 50 

76 51 and 60 

47 61 and 70 

17 Over 70 

3. The Primary Cause. — Whatever cause 
will produce inflammation of the kidneys, 
when there is an ennervation of the organic 
nervous system may produce Brighfs Disease. 
The same may be applied to the lungs in 
consumption. The ennervation is the pre- 
disposing or primary cause and an active or 
exciting cause makes it manifest. 

A predisposing cause, whether it be 
hereditary or acquired, may lie dormant in 
the system for years, as we frequently find 
in consumption, scrofula, Bright's Disease, 
etc., and suddenly be made manifest by a 
cold, or some other exciting cause. If 
physicians, particularly those who make a 
specialty of chronic diseases, were to seek 
more earnestly for the cause, they would 
find their efforts crowned with greater sue- 



SEEKING PRIMARY CAUSE. 141 

cess than they now are. To be successful 
in the treatment of diseases, the primary 
cause must be sought for and removed be- 
fore functional and structural changes, 
which are only the effects, can be checked. 



CHAPTER VIII. 

Advice to Those Suffering From 
Bright's Disease. 

In the acute form there is but little ad- 
vice to give, as disease is ushered in so sud- 
denly, and in many cases symptoms are so 
urgent as to require at once the services of 
a physician. His first efforts will be to re- 
lieve the kidneys ; he will treat other symp- 
toms as the case demands. In the chronic 
form it is different. The disease manifests 
itself insidiously, and progresses very 
slowly. The kidneys are morbidly suscept- 
ible to cold and dampness, from which they 
must be protected ; hence warm clothing is 
indispensable, and must be of such a char- 
acter as to prevent the body from becoming 
chilled, which checks perspiration. Flan- 
nel should be worn the entire year. During 
the winter months the garments should be 
heavy, and consist principally of wool. Cot- 
ton flannels are of very little use; they do 
not prevent the elimination of caloric to any 
great extent. During the summer months 

142 



CLOTHING, DRINKS, etc. 143 

lighter flannels should be worn, to be 
changed for heavier when there is a marked 
fall of temperature. Many patients forget, 
or do not consider it important, to change 
clothing to meet the changes of the weather, 
particularly during the spring and fall 
months. I have for years recommended 
light raw-silk shirts worn under the flannel. 
During the summer months they should 
be worn without the flannel. In Con- 
sumption and chronic Bright's Disease I 
frequently recommend silk shirts, drawers 
and socks, with the happiest results; the 
feet should be well protected from damp- 
ness by wearing double-soled shoes, with 
gum cloth or hog's bladder between the 
soles, to prevent the dampness from striking 
through. If they are double-uppers the 
hog's bladder may also be placed between 
them. Gum shoes may be worn during 
wet and muddy weather, but should be re- 
moved immediately upon entering the 
house. The least dampness of the feet will 
often cause the kidneys to become suddenly 
congested. 

Alcoholic drinks should be avoided, 
unless they are really necessary to assist in 



144 BRIGHT'S DISEASE. 

supporting the system. In such cases, good 
Holland gin or Jamaica rum may be taken 
at meals. The mind should be free from 
care and anxiety, and moderate exercise is 
beneficial rather than otherwise, providing 
there is sufficient rest for nature to recuper- 
ate the brain. Cheerful spirits, a contented 
mind, accompanied with a clear conscience, 
and firm will, will do wonders in warding off 
diseases and prolonging life. A proper 
amount of sleep is very essential ; it enables 
the brain to recover from the depression 
which ennervates the vital energy of the 
organic nervous system through the pneu- 
mo-gastric nerve. All those who have ex- 
perienced the loss of sleep know how it 
depresses the system and how refreshing is 
a good night's rest. The sleeping apart- 
ment should be well ventilated by an open 
fire-place, grate, or some one of the modern 
means of ventilating bed-rooms. The 
lowering or raising of a window is objec- 
tionable for fear of a draught, particularly 
if the room be small and the bed placed near 
enough for the current of air to strike it. 

The diet should be nutritious and of a 
mixed character ; it is customary for physi- 



SUITABLE DIET. 145 

cians to discourage the eating of much ani- 
mal food, on account of increasing the nitro- 
genous products of waste in the blood. 
Animal food is essential for healthy nutri- 
tion, but it may be advisable in the more 
advanced stage of the disease, when there 
is a suppression of the function of the kid- 
neys, to dispense with it. But in the earlier 
stages I would recommend a good nutri- 
tious diet, consisting in ordinary propor- 
tions of animal food. In Bright's Dis- 
ease the trouble lies in the ennervation of 
the organic nervous system. There is 
deficient assimilation of all the products of 
nutrition. Food is of no use unless it is 
properly vitalized ; when taken into the 
system, it is dead matter and must be vital- 
ized before it can supply the wants of the 
organism. This is accomplished during the 
passage of the chyle through the mesenteric 
glands and liver. If assimilation should be 
imperfect, vitalization is deficient, and it 
undergoes chemical change, the same as the 
disintegrated products after life-action has 
been expended, and is eliminated by the 
kidneys and other excretory organs in the 
same manner as products of waste. I there- 
13 



146 BRIGHTS DISEASE. 

fore approve of a mixed diet of a nutri- 
tious character, providing the patient is 
treated with a view to increase the vital 
energy of the nervous system. As it is 
increased, animal food may be given in 
larger quantity once or twice a day, for 
breakfast and dinner. A light supper, con- 
sisting of bread and milk, oatmeal or 
crushed wheat and milk ; this will keep the 
bowels regular, aid digestion and not inter- 
fere with sleep. I would also recommend, 
if there is much debility, milk taken at 
intervals of three or four hours, and, if the 
system seems to require it, I would suggest 
rum or gin punches taken two or three 
times a day. Exercise in the open air, 
either by walking or riding, is conducive to 
health, and, therefore, should be taken ad- 
vantage of whenever opportunity affords. 

Bathing is advisable ; a tepid bath once 
or twice a week, followed by a good rubbing 
of the skin to increase its circulation, is very 
desirable. It relieves the congestion of the 
kidneys and increases the secretion of the 
skin, and thus assists in the elimination of 
urea and uric acid from tbe blood, which 
the kidneys are enabled to do only to a 



BATHING, RUBBING, etc. 147 

limited extent. I have been in the habit of 
recommending to patients, in connection 
with bathing, the rubbing of the skin with 
a coarse crash towel or Turkish rubber, 
saturated with a solution of rock-salt of 
sufficient strength to bear an egg. When 
saturated, it is to be hung up to dry ; the 
body and limbs are to be rubbed with this 
prepared towel once a day, morning or 
evening. After it has been in use one week, 
it is to be washed, dried and again saturated 
and used in the same way. This rubbing 
increases the circulation of the skin, and 
wonderfully relieves the kidneys of their 
congested condition. It accomplishes more, 
it increases the action of the secreting 
glands of the skin and eliminates the pro- 
ducts of waste. 

As regards treatment, I have but little to 
say, as this work is not written for physicians, 
and if the treatment were given, it could not 
be made use of without consulting a phy- 
sician. Therefore, my advice is, to avoid 
quacks as a saint would the fallen angel, 
and place yourself in the hands of a skil- 
ful doctor. There is, however, one form of 
treatment that I must condemn, for I have 



148 BRIGHT'S DISEASE. 

frequently seen its injurious effects. I have 
reference to the administration of iron in 
enormous doses; "saturating the system" 
with it in order to overcome anaemia. This is a 
great mistake for several reasons. In the 
first place, it will not cure anaemia so long 
as the vital energy is so ennervated that it 
cannot carry on a normal assimilation. 
Anaemia results from an impaired vitaliza- 
tion of the chyle in its passage through the 
mesenteric glands, and therefore the white 
corpuscles cannot progress or advance to 
the red corpuscles or blood-discs. There is 
nearly always sufficient of iron in the food 
and drink we take into the system for the 
purposes of the economy. The vital energy 
of the nervous system has its own laboratory 
in which it combines the organic and inor- 
ganic constituents in sufficient quantities to 
suit its purposes, and it is during this com- 
bination that they are vitalized. If there 
should be an excess of any one or more in- 
gredients, it is rejected and eliminated, the 
same as the disintegrated products are by 
the excretory organs. There is another ob- 
jection to giving iron in massive doses, it 
deranges the stomach and irritates the urin- 



SHUN QUACKS. 149 

ary organs, particularly the bladder. If it 
is to be administered at all in Bright's Dis- 
ease, which is questionable, it should be 
given in very small doses, for an exceed- 
ingly small quantity is required for assimi- 
lation. It will thus be seen that instead of 
being beneficial in large doses, it is highly 
injurious. There is another form of treat- 
ment which I must caution those suffering 
from this disease to shun as they would 
their bitterest enemy. I refer to the numer- 
ous remedies, advertised by quacks, for the 
cure of Bright's Disease. They are usually 
powerful diuretics which act upon inflamed 
and irritable kidneys, forcing their function, 
which they are unable to perform owing to 
impaired energy, and thus increasing the 
difficulty. I am not surprised at those afflicted 
with this disease seeking such a source for 
relief, for the regular physician gives the 
patient no encouragement, and he is like a 
drowning person clinging to a straw. The 
kidneys require gentle treatment and any 
remedy administered that will force them 
must be injurious. 

Much more might be said on the subject 
of which this chapter treats, but as our 
13* 



150 BRIGHT'S DISEASE CURABLE. 

space is limited we will conclude by advis- 
ing the patient to avoid quacks and their 
medicines and seek the advice of an intelli- 
gent and skilful physician, and that this be 
done before the disease is too far advanced. 
Chronic Bright's Disease is curable, even 
after the kidneys are seriously disorganized, 
providing the inflammation is removed and 
the energy of the organic nervous system 
re-established. The master-workman — the 
vital force, located in the system, calls for 
help, and if proper assistance be rendered in 
time, it will be enabled to restore the parts 
to their normal condition and re-establish a 
healthy function. 



ANNOUNCEMENT. 

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source, and show how the life principle 

151 






152 ANNOUNCEMENT. 

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